RESUMEN
Painful anal fissures could be distressing conditions that severely impair the patients' quality of life. The analgesic effectiveness of topical drugs, such as calcium-antagonists and nitrates is quite variable. The inhalational anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds.We report a pioneer experience treating a painful chronic anal fissure with topical sevoflurane. A young adult male was suffering from an extremely painful chronic anal fissure, which severely affected his quality of life. The topical treatment with nitroglycerine and diltiazem gels failed. The patient agreed to the treatement with topical sevoflurane as an off-label medication, and it produced an immediate, intense, and long-lasting analgesic effect. An intense but rapidly transient burning sensation, as well as persistent but well-tolerated flatulence were the only adverse effects. The quality of life was greatly improved, and the cost of the treatment was affordable. Therefore, the off-label use of topical sevoflurane appears to be an effective alternative for the symptomatic treatment of painful anal fissures (AU)
As fissuras anais dolorosas podem ser condições angustiantes que prejudicam gravemente a qualidade de vida dos pacientes. A eficácia analgésica de medicamentos tópicos, como antagonistas de cálcio e nitratos, é bastante variável. O anestésico inalatório sevoflurano está sendo reaproveitado como analgésico tópico para feridas crônicas dolorosas. Relatamos uma experiência pioneira de tratamento com sevoflurano tópico em fissura anal crônica dolorosa. Umjovemadulto do sexomasculino sofria de uma fissura anal crônica extremamente dolorosa, que afetava gravemente sua qualidade de vida. O tratamento tópico com nitroglicerina e géis de diltiazem foi ineficaz. O paciente concordou com o tratamento com sevoflurano tópico como medicamento off-label, ou seja, com uso diferente do aprovado embula. O sevoflurano tópico produziu um efeito analgésico imediato, intenso e duradouro. Uma sensação de ardência intensa, mas transitória, e flatulência persistente, embora bem tolerada, foram os únicos efeitos adversos. A qualidade de vidamelhorou significativamente, e o custo do tratamento revelou-se acessível. Portanto, o uso off-label de sevoflurano tópico pode ser uma alternativa analgésica eficaz em casos de fissuras anais dolorosas. (AU)
Asunto(s)
Humanos , Masculino , Adulto , Calidad de Vida , Fisura Anal/tratamiento farmacológico , Sevoflurano/uso terapéutico , Analgesia , Dolor/tratamiento farmacológico , Resultado del TratamientoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Pancreatitis/complicaciones , Pancreatitis/cirugía , Pancreatitis , Ictericia Obstructiva/complicaciones , Ictericia Obstructiva , Tomografía Computarizada de Emisión/métodos , Tomografía Computarizada de Emisión/tendencias , Inmunosupresores/uso terapéutico , Corticoesteroides/uso terapéutico , Pancreatitis/patología , Endoscopía/métodos , Endoscopía , Constricción Patológica/cirugía , Constricción Patológica , Conducto Colédoco/patología , Conducto Colédoco/cirugía , Conducto Colédoco , Biomarcadores de Tumor/análisisRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hígado/fisiopatología , Brucelosis/fisiopatología , Neoplasias Hepáticas/fisiopatología , Neoplasias Hepáticas/cirugía , Brucelosis/complicaciones , Brucelosis/tratamiento farmacológico , Hígado/lesiones , Diagnóstico Diferencial , Proteína C-Reactiva/uso terapéutico , Drenaje/métodosRESUMEN
BACKGROUND: Infections caused by multi-drug-resistant organisms are too common and represent a therapeutic challenge. Topical application of sevoflurane may be useful for the treatment of cutaneous infections, as this general anesthetic has antimicrobial properties in vitro. CASE REPORT: A 43-year-old male patient received a liver transplant because of cirrhosis caused by hepatitis C. The surgical site was infected initially by multi-drug-resistant Pseudomonas aeruginosa that was susceptible to colistin, but parenteral administration of this antibiotic led to deterioration of renal function and was discontinued. The incision did not heal with daily lavage and debridement and was superinfected with Staphylococcus aureus. The off-label use of liquid sevoflurane in the form of site irrigations was followed by healing and closure of the site. This healing could be attributable to the mixed effect of three possible actions of sevoflurane: Direct antimicrobial effect, local analgesic effect that improved the quality of the dressings, and a direct vasodilator effect that, in theory, increased the supply of nutrients to the incision bed. CONCLUSIONS: The use of liquid sevoflurane on sites infected by microorganisms resistant to conventional antibiotics appears to be an attractive therapeutic option that deserves future research.
Asunto(s)
Antiinfecciosos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Éteres Metílicos/uso terapéutico , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Cicatrización de Heridas/efectos de los fármacos , Administración Tópica , Adulto , Hepatitis C Crónica/complicaciones , Humanos , Huésped Inmunocomprometido , Cirrosis Hepática/cirugía , Trasplante de Hígado/efectos adversos , Masculino , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificación , Sevoflurano , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Resultado del TratamientoAsunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Vesícula Biliar/patología , Vesícula Biliar , Apendicitis/complicaciones , Abdomen Agudo/diagnóstico , Colecistectomía , Colecistitis Alitiásica/complicaciones , Colecistitis Alitiásica/diagnóstico , Colecistitis Alitiásica , Colecistitis Aguda/complicaciones , Laparoscopía , Apendicitis/patología , Apendicitis/diagnóstico , Apendicitis , Abdomen Agudo/fisiopatología , Abdomen Agudo , Dolor Abdominal/etiología , Dolor AbdominalAsunto(s)
Apendicitis/diagnóstico , Errores Diagnósticos , Enfermedades de la Vesícula Biliar/diagnóstico , Anomalía Torsional/diagnóstico , Abdomen Agudo/etiología , Enfermedad Aguda , Anciano de 80 o más Años , Colecistectomía , Colecistitis/complicaciones , Colecistitis/cirugía , Urgencias Médicas , Enfermedades de la Vesícula Biliar/complicaciones , Enfermedades de la Vesícula Biliar/cirugía , Humanos , Masculino , Anomalía Torsional/complicaciones , Anomalía Torsional/cirugíaRESUMEN
No disponible
No disponible
Asunto(s)
Humanos , Femenino , Anciano , Hernia Ventral/complicaciones , Hernia Ventral , Enfermedades Intestinales/complicaciones , Enfermedades Intestinales , Enfermedades Renales Quísticas/complicaciones , Tomografía Computarizada por Rayos X , Enfermedades Renales QuísticasAsunto(s)
Hernia Ventral/complicaciones , Enfermedades Intestinales/complicaciones , Enfermedades Renales Quísticas/complicaciones , Anciano , Femenino , Hernia Ventral/diagnóstico por imagen , Humanos , Enfermedades Intestinales/diagnóstico por imagen , Enfermedades Renales Quísticas/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Se entiende por síndrome posneumonectomía la obstrucción bronquial postoperatoria, causada por un desplazamiento exagerado del mediastino. Este síndrome está bien documentado en la literatura médica como complicación tardía de una neumonectomía derecha, pero su producción tras una resección del pulmón izquierdo es excepcional, pues apenas se ha publicado una decena de casos. La fisiopatología, las manifestaciones clínicas, el pronóstico y el tratamiento son similares para ambos lados.Presentamos el caso de un paciente adulto a quien se practicó una neumonectomía izquierda y que desarrolló un síndrome posneumonectomía a los 15 meses del postoperatorio. La estenosis del bronquio intermediario se produjo entre el cuerpo vertebral y la arteria pulmonar derecha. Se efectuó eficazmente tratamiento endoscópico con una prótesis metálica autoexpandible, con lo cual se observó la remisión completa de los síntomas durante los 6 meses de seguimiento(AU)
Postpneumonectomy syndrome is characterized by postoperative bronchial obstruction caused by mediastinal shift. The syndrome is well documented in the medical literature as a late complication of right pneumonectomy; however, it rarely occurs following resection of the left lung, and only 10 cases have been published. The pathophysiology, clinical manifestations, prognosis, and treatment are similar for both sides of the lung.We present the case of an adult patient who underwent left pneumonectomy and developed postpneumonectomy syndrome 15 months later. Stenosis of the intermediate bronchus occurred between the vertebral body and the right pulmonary artery. Endoscopic treatment with a self-expanding metal stent was successful, and complete remission was observed over the 6 months of follow-up(AU)
Asunto(s)
Humanos , Masculino , Adulto , Neumonectomía , Endoscopía , Endoscopios , Estenosis de la Válvula Pulmonar/cirugía , Estenosis de la Válvula Pulmonar/terapia , Constricción Patológica , HiperplasiaRESUMEN
Postpneumonectomy syndrome is characterized by postoperative bronchial obstruction caused by mediastinal shift. The syndrome is well documented in the medical literature as a late complication of right pneumonectomy; however, it rarely occurs following resection of the left lung, and only 10 cases have been published. The pathophysiology, clinical manifestations, prognosis, and treatment are similar for both sides of the lung. We present the case of an adult patient who underwent left pneumonectomy and developed postpneumonectomy syndrome 15 months later. Stenosis of the intermediate bronchus occurred between the vertebral body and the right pulmonary artery. Endoscopic treatment with a self-expanding metal stent was successful, and complete remission was observed over the 6 months of follow-up.