RESUMEN
OBJECTIVES: Anastomotic ulceration (AU) is a rare but life-threatening complication of pediatric short bowel syndrome (SBS). AUs may be challenging to detect and refractory to treatment. This study aimed to identify features associated with symptomatic bleeding AUs in children with SBS and factors that may impact resolution of bleeding. The relationship between dietary changes and symptomatic anastomotic hemorrhage was also explored. METHODS: We conducted a retrospective chart review of 381 patients cared for in the Intestinal Rehabilitation Program at our center from 2013 to 2022. Patients with symptomatic AUs were identified based on at least 1 endoscopic procedure showing AUs and evidence of clinically significant gastrointestinal bleeding. We collected patient demographics, clinical characteristics, dietary history, radiologic imaging, and histopathology. We used descriptive statistics to identify patterns of presentation. RESULTS: AUs were identified in 22 patients who were followed for a median duration of 2.9 years after anastomotic ulcer identification. AUs uniformly evolved years after the initial anastomosis (median 3.2 years). Characteristics included bowel stricture (4/22), small bowel-colon anastomosis (19/22), partial colectomy (17/22), and an increase in whole foods fraction (12/18). Bleeding resolved with operative intervention in the majority with anastomotic stricture (3/4). Recurrent bleeding was common in those without stricture (13/18). In a subset of patients without stricture, whole food reduction was associated with improvement or resolution of bleeding (5/6). CONCLUSIONS: We observed a higher proportion of patients with AUs who responded to surgical intervention in the subset of children with definitive anastomotic strictures versus those without, suggesting that careful characterization of intestinal anatomy may be critical to predicting response to therapy. We also observed that bleeding from AU typically first manifested within 1 year of a shift from elemental or hydrolyzed enteral formula to a whole food-based diet (including commercial blenderized feeds), which may indicate that components of the enteral diet play a role in the pathogenesis of AU. Further studies are needed to validate these hypotheses.
Asunto(s)
Obstrucción Intestinal , Síndrome del Intestino Corto , Humanos , Niño , Síndrome del Intestino Corto/complicaciones , Síndrome del Intestino Corto/cirugía , Estudios Retrospectivos , Constricción Patológica/etiología , Estudios de Seguimiento , Úlcera/etiología , Úlcera/cirugía , Anastomosis Quirúrgica/efectos adversos , Obstrucción Intestinal/etiología , Resultado del TratamientoRESUMEN
We report a case of a 58-year-old man with multiple symptomatic penetrating atherosclerotic ulcers and concomitant intramural hematoma of the ascending aorta. The patient was successfully treated using a 24-mm Gelweave graft in the ascending aorta. He was discharged four days post operation and remains asymptomatic 14 months postoperatively. This case uniquely illustrates the rare entity of penetrating atherosclerotic ulcer with intramural hematoma, which presents in only 0.28% of all acute aortic syndrome cases.
Asunto(s)
Enfermedades de la Aorta , Aterosclerosis , Aorta/diagnóstico por imagen , Aorta/cirugía , Aorta Torácica , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Hematoma/diagnóstico por imagen , Hematoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Úlcera/complicaciones , Úlcera/diagnóstico por imagen , Úlcera/cirugíaRESUMEN
O objetivo desse trabalho foi relatar um caso onde foi usado a hidrodissecção para auxiliar na remoção da aderência de flap conjuntival em 360° em córnea, em um cão. Foi atendido um cão da raça buldogue francês, macho, 2 anos, 18 kg, apresentando olho esquerdo com presença de um flap conjuntival em 360°, em decorrência de tratamento prévio de uma úlcera em melting extensa há 40 dias. Após a realização de exames pré-operatórios de rotina, o paciente foi submetido a um novo procedimento cirúrgico para remoção do flap. Para isso foi realizada a técnica de hidrodissecção, que consistiu na injeção de 2 mL cloreto de sódio a 0,9% sob flap o conjuntival, seguida pela divulsão com tesoura de íris, removendo a aderência entre conjuntiva e córnea. O paciente apresentou excelente recuperação pós-operatória, com diminuição da cicatriz na córnea e ausência de inflamação da conjuntiva ao longo de três meses de avaliações seriadas. Concluiu-se que a técnica de hidrodissecção facilitou a remoção do flap conjuntival de 360° no paciente do presente caso, tornando-se uma manobra em potencial para utilização em outros procedimentos semelhantes.(AU)
The aim of this case report is to present a case where it was used hydrodissection to remove a 360° conjunctival flap° from a dog. A 2 year old, male french bulldog weighting 18 kg was taken to a veterinary service with a 360° conjunctival flap in its left eye due to a previous treatment of an extensive melting ulcer for the past 40 days. After performing routine preoperative exams, a new surgical procedure was performed to remove the flap. The technique of choice was hydrodissection, which consisted of injecting 2 mL of 0.9% sodium chloride under conjunctival flap, followed by the divulsion, releasing the conjunctiva from its corneal bed with the use of iris scissors until complete removal of the tissue. The patient showed excellent postoperative recovery, with decreased corneal scarring and no inflammation of the conjunctiva over 3 months of post op evaluation. The hydrodissection technique has facilitated the removal of the 360° conjunctival flap in this present case, making it a potential technique of choice in other similar procedures.(AU)
Asunto(s)
Animales , Perros , Perros , Endonucleasas de ADN Solapado , Úlcera/cirugíaRESUMEN
O objetivo desse trabalho foi relatar um caso onde foi usado a hidrodissecção para auxiliar na remoção da aderência de flap conjuntival em 360° em córnea, em um cão. Foi atendido um cão da raça buldogue francês, macho, 2 anos, 18 kg, apresentando olho esquerdo com presença de um flap conjuntival em 360°, em decorrência de tratamento prévio de uma úlcera em melting extensa há 40 dias. Após a realização de exames pré-operatórios de rotina, o paciente foi submetido a um novo procedimento cirúrgico para remoção do flap. Para isso foi realizada a técnica de hidrodissecção, que consistiu na injeção de 2 mL cloreto de sódio a 0,9% sob flap o conjuntival, seguida pela divulsão com tesoura de íris, removendo a aderência entre conjuntiva e córnea. O paciente apresentou excelente recuperação pós-operatória, com diminuição da cicatriz na córnea e ausência de inflamação da conjuntiva ao longo de três meses de avaliações seriadas. Concluiu-se que a técnica de hidrodissecção facilitou a remoção do flap conjuntival de 360° no paciente do presente caso, tornando-se uma manobra em potencial para utilização em outros procedimentos semelhantes.
The aim of this case report is to present a case where it was used hydrodissection to remove a 360° conjunctival flap° from a dog. A 2 year old, male french bulldog weighting 18 kg was taken to a veterinary service with a 360° conjunctival flap in its left eye due to a previous treatment of an extensive melting ulcer for the past 40 days. After performing routine preoperative exams, a new surgical procedure was performed to remove the flap. The technique of choice was hydrodissection, which consisted of injecting 2 mL of 0.9% sodium chloride under conjunctival flap, followed by the divulsion, releasing the conjunctiva from its corneal bed with the use of iris scissors until complete removal of the tissue. The patient showed excellent postoperative recovery, with decreased corneal scarring and no inflammation of the conjunctiva over 3 months of post op evaluation. The hydrodissection technique has facilitated the removal of the 360° conjunctival flap in this present case, making it a potential technique of choice in other similar procedures.
Asunto(s)
Animales , Perros , Perros , Endonucleasas de ADN Solapado , Úlcera/cirugíaRESUMEN
Introdução: A úlcera por pressão (UPP) é uma das complicações mais comuns em portadores de lesão medular, dos mais graves e frequentes problemas destes pacientes. A incidência e evolução depende dos grupos estudados, tendo as crianças e adolescentes características específicas durante o crescimento. A maior parte das descrições na literatura referem-se a adultos que desenvolveram UPP durante internação. O objetivo é descrever os resultados de pacientes operados para fechamento de úlcera por pressão na unidade de Pediatria do Hospital Sarah Brasília. Métodos: Estudo descritivo, retrospectivo de pacientes operados de 2005 a 2010 devido à lesão por pressão e análise estatística. Resultados: 116 pacientes foram admitidos para tratamento cirúrgico de UPP no Hospital Sarah, sendo 20 (17,2%) internados na Pediatria; 15 (75%) homens e 5 (25%) mulheres, todos provenientes de ambiente comunitário; 60% localizadas na região isquiática; com seguimento de 15 anos; 70% eram portadores de malformação do tubo neural. Os procedimentos cirúrgicos foram indicados para úlcera por pressão grau III e IV. Utilizou-se retalho do músculo glúteo (3), em ilha (8) ou península (3), fechamento primário e coccigectomia; retalho do músculo tensor da fáscia lata. Três casos apresentaram complicações, 65% evoluíram com recidiva e 15% com surgimento de novas lesões na região pélvica. Conclusão: A principal causa de lesão por pressão em Pediatria foi devido à malformação do tubo neural (70%), adquiridas na comunidade, localizadas na região isquiática. Embora estivessem em atendimento no programa de reabilitação, ainda foi observado alto índice de recidivas (65%).
Introduction: Pressure ulcers (PUs), or pressure sores, are among the most common serious complications in patients with spinal cord injury. The incidence and evolution in children and adolescents have specific characteristics. Most prior reports evaluated adults who developed PUs in the hospital. The objective is to describe the outcomes of surgical PU closure in children and adolescents in the Hospital Sarah Brasília pediatric unit. Methods: This was a retrospective statistical analysis of patients who underwent surgery for PUs. Statistical analysis of the incidence of PUs was performed using Epi Info version 3.2.2. Results: Of 116 patients who underwent surgery for PUs at the Hospital Sarah between 2005 and 2010, 20 (17.2%) were admitted to the Pediatric Unit. All 15 (75%) male and 5 (25%) female patients were admitted from a community setting. PUs were located in the ischial region in 60% of patients. The followup period was 15 years. Neural tube malformations were present in 70% of patients. We performed surgery for grade III and IV PUs, using gluteal flaps, primary closure and coccygectomy, and tensor fascia lata flaps. Three cases had complications, 65% developed recurrences, and 15% developed new ulcers in the pelvic region. Conclusion: The main cause of PUs in pediatric cases admitted to the rehabilitation hospital was a neural tube malformation (70%) in the ischial region. Despite admission to the rehabilitation program, a high recurrence rate (65%) was observed.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Historia del Siglo XXI , Pediatría , Rehabilitación , Ciática , Procedimientos Quirúrgicos Operativos , Úlcera , Estudios Retrospectivos , Úlcera por Presión , Tubo Neural , Pediatría/métodos , Rehabilitación/métodos , Ciática/cirugía , Ciática/terapia , Procedimientos Quirúrgicos Operativos/métodos , Úlcera/cirugía , Úlcera por Presión/cirugía , Úlcera por Presión/complicaciones , Úlcera por Presión/terapia , Tubo Neural/cirugíaRESUMEN
Penetrating aortic ulcer (PAU) is an ulceration of an atherosclerotic plaque which disrupts the aortic internal elastic lamina and that can evolve to an intramural hematoma (IH), aortic dissection or aortic rupture. We report two cases with PAU. A 73 year-old woman with a history of hypertension, presented with acute chest pain of three days of evolution and a hypertensive emergency. An electrocardiogram showed ST-segment elevation and elevated cardiac enzymes. Computed tomography (CT) scans showed an acute ascending aortic mural hematoma secondary to PAU and hemopericardium. Replacement of ascending aorta was performed with a vascular prosthesis with extracorporeal circulation (ECC). PAU and IH were confirmed by histopathology. A 62-year old woman with a history of hypertension, diabetes and chronic obstructive pulmonary disease, consulted for abdominal pain of two days of evolution. A thoracic-abdominal CT scan visualized an uncomplicated PAU and an abdominal aortic aneurysm. Because of abdominal pain and signs of peritoneal irritation, an exploratory laparotomy was performed finding a typhlitis. Resection and ileo-ascendo-anastomosis were performed. A new CT scan showed PAU with high risk of rupture without a clinical acute aortic syndrome. The patient was operated replacing the ascending aorta with a vascular prosthesis using ECC. Three PAU were found. Histopathology confirmed the diagnosis. Both patients evolved without postoperative complications.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Anciano , Aorta/cirugía , Aorta/diagnóstico por imagen , Aorta Torácica/cirugía , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Úlcera/cirugía , Úlcera/diagnóstico por imagen , Tomografía Computarizada por Rayos X , ElectrocardiografíaAsunto(s)
Aorta Torácica/cirugía , Aorta/diagnóstico por imagen , Aorta/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/cirugía , Úlcera/cirugía , Anciano , Electrocardiografía , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Úlcera/diagnóstico por imagenRESUMEN
El término úlcera de Marjolin, engloba todo proceso maligno que surja a partir de un tejido cicatricial, 5 % de los car-cinomas epidermoides; el pilar del tratamiento es el quirúrgico, puede tornarse multidisciplinario; con radio/quimioterapia. Las opciones quirúrgicas son resecciones locales, amplias, incluso amputaciones, y el tratamiento de las metástasis linfáticas; vaciamientos linfocelulares. A continuación se presenta un caso clínico sobre el manejo quirúrgico de una úlcera de Marjolin en un paciente de 29 años.
The concept Marjolin's ulcer, include all malignant processes from scar tissue, 5% of squamous cell carcinomas; The pillar of treatment is surgical, can become multidisciplinary; With radio / chemotherapy. Surgical options are local, extensive resections, including amputations, and treatment of lymphatic metastases; Lymphocellularemptyings. The following is a case report on the surgical management of a Marjolin ulcer in a 29-year-old patient.
Asunto(s)
Masculino , Humanos , Adulto , Quemaduras/complicaciones , Úlcera/cirugía , NeoplasiasRESUMEN
Brucellosis is the most common bacterial zoonosis, and causes a considerable burden of disease in endemic countries. Cardiovascular involvement is the main cause of mortality due to infection with Brucella spp, and most commonly manifests as endocarditis, peripheral and cerebrovascular aneurysms, or arterial and venous thromboses. We report a case of brucellosis presenting as bacteraemia and aortic endarteritis 18 years after the last known exposure to risk factors for brucella infection. The patient was treated with doxycycline, rifampicin, and gentamicin, and underwent surgical repair of a penetrating aortic ulcer, with a good clinical recovery. We review the signs and symptoms, diagnostic approach, prognosis, and treatment of brucella arteritis. We draw attention to the absence of consensus about the optimum therapy for vascular brucellosis, and the urgent need for additional studies and renewed scientific interest in this major pathogen.
Asunto(s)
Antibacterianos/uso terapéutico , Brucella abortus/aislamiento & purificación , Brucelosis/diagnóstico , Endarteritis/microbiología , Mataderos , Anciano , Animales , Enfermedades de la Aorta/cirugía , Bacteriemia/diagnóstico , Prótesis Vascular , Brucelosis/microbiología , Brucelosis/terapia , Doxiciclina/uso terapéutico , Ecuador/etnología , Endarteritis/diagnóstico , Endarteritis/terapia , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/terapia , Gentamicinas/uso terapéutico , Humanos , Masculino , Exposición Profesional , Pronóstico , Rifampin/uso terapéutico , Úlcera/cirugíaRESUMEN
OBJECTIVE: Acute type A aortic syndromes and its chronic complications are fatal diseases traditionally treated by open surgery, with high mortality rates. An endovascular approach to the ascending aorta could reduce the morbidity and mortality associated with open surgery. Our aim was to report our initial experience in treating ascending aortic pathology using commercially available descending thoracic endografts. METHODS: From 2007 to 2012, 69 patients presented to our center in Belo Horizonte, Brazil, with acute type A aortic syndrome or its chronic complications. Of the 69 patients, 8 high-risk patients had suitable anatomy, and 7 agreed to participate in the present study. RESULTS: Of the 7 patients, 4 had penetrating ulcers, 2 had acute dissections, and 1 had chronic dissection with an aneurysm. The technical success rate was 87%, with 1 intraoperative death from acute aortic valve insufficiency. The proximal landing zone was, on average, 21 mm above the aortic valve in all patients. Three patients required intraoperative cervical debranching due to a lesion in the distal third of the ascending aorta, compromising the supra-aortic branches. The distal landing zone was at zone 0 in 4 patients, zone 2 in 1 patient, and in zone 4 in 2 patients. The mean follow-up was 26.3 months. Two repeat dissections developed an average of 2 months after treatment. Both presented with acute dissection that was treated with additional open surgery and both patients survived. Thereafter, no patient had presented again with an acute aortic syndrome or other referable symptoms. CONCLUSIONS: Endovascular treatment of the ascending aorta is feasible. We had 4 good mid-term results in 7 patients who had presented with penetrating ulcers or aneurysm formation. Acute dissections seem to be more unstable, and additional research is mandatory.
Asunto(s)
Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Stents , Úlcera/cirugía , Anciano , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/mortalidad , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Brasil , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Estudios de Factibilidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Reoperación , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Úlcera/diagnóstico , Úlcera/mortalidadRESUMEN
Contexto: O manuscrito descreve a reparação cirúrgica de uma úlcera crônica resultante da picada de uma aranhamarrom,um problema de difícil resolução, o qual habitualmente demora meses até a cicatrização.Descrição do caso: A vítima foi picada na coxa direita e desenvolveu fases de envenenamento típicas da picada deLoxosceles, incluindo a placa mármore, a escara e a úlcera profunda e de bordos emoldurados, características doacidente. Devido ao processo cicatricial lento, cuidados intensivos com curativos, dificuldade na deambulação, além dofator estético, optou-se por cirurgia excisional da lesão e sutura direta das bordas. O tratamento cirúrgico proporcionoucicatrização total da lesão dentro de 15 dias.Conclusões: A úlcera loxoscélica apresenta difícil cicatrização, evoluindo para a cronicidade. A cirurgia com excisãocompleta e síntese primária constitui técnica adequada para a cura da doença.
Asunto(s)
Humanos , Masculino , Adulto , Arañas/patogenicidad , Heridas y Lesiones/rehabilitación , Mordeduras y Picaduras/cirugía , Mordeduras y Picaduras/rehabilitación , Úlcera/cirugía , Úlcera/etiologíaRESUMEN
Para el cirujano, o el clínico, el desbridamiento de una úlcera en forma correcta y adecuada tiene un significado primordial, aun cuando no exista infección aguda o gruesa necrosis. Tiene vital importancia, el tener en cuenta nuevos conceptos como la presencia de métalo-proteasas, las células y fibroblastos senescentes, el biofilm bacteriano, o sea, todo aquello que contribuya a la presencia de un ambiente local crónico inflamatorio y patológico. Este articulo tiene el objetivo de acercar al médico que atiende las heridas de difícil cicatrización o úlceras, a la realidad del cuadro clínico que tiene ante sí. Se hizo una revisión bibliográfica de los artículos relacionados con el tema y se tomaron para ello referencias de hasta diez años. Se exponen criterios de los diferentes autores. Se ofrece desde los conceptos más utilizados, hasta los diferentes métodos utilizados en el mundo medico de hoy en día, a la vez que se actualizan conceptos útiles y prácticos en cuanto a qué, cuándo y cómo, debe realizarse un desbridamiento terapéutico y sus beneficios. El desbridamiento constituye para el médico un arte muy necesario de aprender y desarrollar para obtener los mejores resultados favorables al paciente, pero el control de los factores de riesgo, como el hábito de fumar, el control de la diabetes, el tratamiento de las vasculopatías venosas o arteriales asociadas y el estado nutricional, son elementos guías que todo médico debe seguir y evaluar ante su paciente portador de una herida de difícil cicatrización o úlcera crónica(AU)
Debridement of an ulcer in a correct and proper way is fundamental for the surgeon or the clinician, even if there is neither acute infection nor gross necrosis. It is vital to bear in mind acute new concepts such as the presence of metalloproteases, senescent cells and fibroblasts and bacterial biofilm, i.e. everything that contributes to the existence of local chronic inflammatory and pathological environment. This article was aimed at bringing the doctor treating difficult healing wounds or chronic ulcers closer to the realities of the clinical picture that he/she is facing. A literature review related to this topic covering 10 years was made. The criteria of several authors, the most used concepts and the latest methods in today's medical world, in addition to the updating on useful and practical concepts on when and how to perform the therapeutic debridement and its advantages were all presented in this paper. It is essential for the physician to learn and to develop the art of debridement in order to achieve the best satisfactory results for the patients. However, risk factors such as smoking, diabetes control, associated venous or arterial vasculopathy treatment and nutritional status of the patient are guiding elements that every physician should take into account and evaluate when assisting a patient with difficult healing wound or with chronic ulcer(AU)
Asunto(s)
Desbridamiento/métodos , Úlcera/cirugía , Infección de HeridasRESUMEN
La úlcera penetrante de aorta describe una condición en la que una placa ateroesclerótica se ulcera y penetra con las laminas elástica interna y media de la aorta. Esta lesión puede asociarse o complicarse con la formación de un hematoma intramural, disección, dilatación aneurismática, pseudoaneurisma o ruptura de la aorta. Se presenta el caso de un paciente masculino de 58 años quien consultó a urgencias con disnea, síncope y dolor torácico agudo con diagnosticó final de úlcera aórtica penetrante.
Penetrating aortic ulcer describes the condition in which an ulceration of an atherosclerotic plaque penetrates the internal and medial elastic laminas of the aorta. This lesion can be associated or complicated with the formation of an intramural hematoma, dissection,aneurysmatic dilatation, pseudo aneurysm or aortic rupture. We report the case of a 58 year old male who entered the emergency department with dispnoea, syncope and acute chest pain, with final diagnosis of penetrating aortic ulcer.
Asunto(s)
Humanos , Masculino , Femenino , Aorta Torácica/cirugía , Aorta Torácica/patología , Arteriosclerosis/cirugía , Úlcera/cirugíaRESUMEN
BACKGROUND: Pressure ulcers are defined as lesions of ischemic etiology in the skin or soft tissue. These lesions are secondary to increased external pressure and usually occur over bony prominences. Classification of various stages of pressure ulcers is important for the development of therapeutic strategies. The fundamental surgical treatments are debridement and excision of underlying bursa and involved bone tissue, followed by tissue coverage. This study reports our experience in repairing pressure ulcers and analyzes patient characteristics, outcomes, and complications. METHODS: A total of 33 pressure ulcers were treated in 17 patients, the most prevalent of which was sacral ulcer. The development of pressure ulcers in hospitals accounted for 82 percent of the cases. Treatment options included debridement, primary synthesis, random skin flaps, rhomboid skin flap, myocutaneous flaps of the gluteus maximus in V-Y, classic fasciocutaneous flaps of fascia lata, fasciocutaneous flap of fascia lata in V-Y, and posterior fasciocutaneous flaps of the thigh in V-Y. RESULTS: Complications occurred in 39 percent of cases. Preoperative anemia was associated with complications. CONCLUSIONS: Pressure ulcers can be avoided in most cases, given sufficient knowledge of their pathogenesis and correct management of patients at risk. Multi-professional and family participation is essential for the treatment of patients with pressure ulcers since complications, recurrence, and the incidence of new ulcers are common. Complication risk factors such as anemia should be avoided in order to provide a better prognosis and proper closure of the ulcer.
INTRODUÇÃO: Úlceras por pressão são definidas como lesões cutâneas ou de partes moles de etiologia isquêmica, secundárias ao aumento da pressão externa, predominando sobre proeminência óssea. A classificação em estágios é importante na elaboração de estratégias terapêuticas. Os princípios fundamentais no tratamento cirúrgico são: debridamento e exérese de bursa subjacente e tecido ósseo envolvido, seguida de cobertura tecidual. Este estudo teve por objetivo relatar a experiência em reparação de úlceras por pressão, analisando características dos pacientes, resultados e complicações. MÉTODO: Em 17 pacientes, foram tratadas 33 úlceras por pressão, sendo a localização sacral a mais prevalente. O desenvolvimento de úlceras por pressão no ambiente hospitalar correspondeu a 82 por cento dos casos. As opções de tratamento foram: debridamento, síntese primária, retalhos cutâneos ao acaso, retalho cutâneo romboide, retalhos miocutâneos de glúteo máximo em V-Y, retalhos fasciocutâneos de fascia lata clássicos, retalho fasciocutâneo de fascia lata em V-Y, e retalhos fasciocutâneos posteriors da coxa em V-Y. RESULTADOS: Complicações ocorreram em 39 por cento dos casos. A anemia pré-operatória foi associada a complicações. CONCLUSÕES: O conhecimento da patogênese da úlcera por pressão e o correto manejo do paciente de risco podem evitá-la na maioria dos casos. É indispensável a participação multiprofissional e dos familiares para o tratamento do paciente portador de úlcera por pressão, pois complicações, recidivas e incidência de novas úlceras são comuns. Fatores de risco para complicações, como anemia, devem ser evitados, para obtenção de melhor prognóstico e fechamento adequado da úlcera.
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Anciano , Historia del Siglo XXI , Complicaciones Posoperatorias , Neoplasias de los Tejidos Blandos , Colgajos Quirúrgicos , Úlcera , Nalgas , Factores de Riesgo , Úlcera por Presión , Anemia , Complicaciones Intraoperatorias , Complicaciones Posoperatorias/terapia , Neoplasias de los Tejidos Blandos/cirugía , Neoplasias de los Tejidos Blandos/terapia , Colgajos Quirúrgicos/cirugía , Úlcera/cirugía , Nalgas/cirugía , Úlcera por Presión/cirugía , Úlcera por Presión/etiología , Anemia/complicaciones , Anemia/terapia , Complicaciones Intraoperatorias/terapiaRESUMEN
A úlcera penetrante de aorta é uma variante da dissecção aórtica clássica que apresenta características histopatológicas peculiares. Estas lesões se desenvolvem a partir de placas ateromatosas ulceradas que se estendem através da íntima. O reparo endovascular é considerado uma alternativa segura e menos invasiva; no entanto, o manejo desta enfermidade ainda constitui um desafio para o cirurgião. Objetivo: Relatar o caso de um paciente do sexo masculino, 61 anos, portador de úlcera de aorta torácica que evoluiu com perfuração e dissecção aórtica, a qual se manteve tamponada durante 13 meses, até o seu tratamento definitivo. Método: As informações necessárias foram obtidas por meio de revisão de prontuário, entrevista com o paciente e registro fotográfico de métodos de diagnóstico por imagem aos quais o paciente foi submetido. Considerações finais: O paciente, embora tardiamente, foi submetido com sucesso ao tratamento endovascular de úlcera penetrante de aorta e evoluiu sem intercorrências graves durante e após o procedimento terapêutico. Cada vez mais casos bem-sucedidos de tratamento endovascular de úlceras e outras doenças da aorta vêm sendo relatados e parece haver uma expectativa da comunidade médica de que, em breve, esta modalidade se firme como o padrão no tratamento destas enfermidades
The penetrating aortic ulcer is a particular variety of the classic aortic dissection with peculiar histological findings. These lesions develop from ulcerating atheromatous plaques that extend through the intima. The endovascular procedure is considered a safe and less invasive method of treatment, but the management of this disease is still seen as a challenge for the surgeon. Aim: To relate a case of a male patient of 61 years old that had an aortic ulcer witch has suffered perforation and produced an aortic dissection. The aortic perforation remained stable during 13 months until the patient has received the definitive treatment. Method: The necessary data was obtained by medical chart review, interview with the patient and photographic register of the image diagnose exams that were performed. Final considerations: The patient, even through with delay, was successful submitted to endovascular treatment for penetrating aortic ulcer and has suffered no severe complications during and after the procedure. Recently more and more well-succeed cases of encovascular treatment for the penetrating ulcer and other pathologies of the aorta have been described and it seems to exist an expectance of the medical community that, shortly, this modality will be recognized as the gold standard to manage these diseases
Asunto(s)
Humanos , Masculino , Aorta Torácica/cirugía , Aorta/lesiones , Disección , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/fisiopatología , Enfermedades de la Aorta , Rotura de la Aorta/cirugía , Úlcera/cirugía , Procedimientos Quirúrgicos Vasculares , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Penetrating aortic atherosclerotic ulcer is an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.
Asunto(s)
Enfermedades de la Aorta/cirugía , Procedimientos Endovasculares/métodos , Stents , Úlcera/cirugía , Anciano de 80 o más Años , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A úlcera aterosclerótica penetrante de aorta é uma patologia subdiagnosticada que apresenta altas taxas de morbimortalidade. Relatamos dois casos de pacientes com dor torácica intensa sem características isquêmicas que foram submetidos a angiotomografia de tórax e apresentaram ulceração na parede da aorta com penetração de contraste na camada média. Em razão da falha no tratamento clínico, foram submetidos a implante percutâneo de endoprótese aórtica com resolução completa dos sintomas.
Penet rat ing aor t ic atherosclerot ic ulcer i s an underdiagnosed condition that presents high rates of morbidity and mortality. We report two cases of patients with severe chest pain, with no ischemic features, who underwent chest angiotomography and showed an ulceration of the aortic wall, with contrast penetration into the middle layer. Due to the failure of the medical treatment, the patients underwent percutaneous aortic stent implantation with complete resolution of symptoms.
La úlcera aterosclerótica penetrante de aorta es una patología subdiagnosticada que presenta altas tasas de morbimortalidad. Referimos dos casos de pacientes con dolor torácico intenso sin características isquémicas que se sometieron a una angiotomografía de tórax y presentaron ulceración en la pared de la aorta con penetración de contraste en la capa media. En razón de la falta en el tratamiento clínico, se sometieron a implantación percutánea de endoprótesis aórtica con resolución completa de los síntomas.