RESUMO
OBJECTIVE: To describe the perioperative characteristics, complications and outcome of the first 22 patients who underwent laparoscopic splenectomy for refractary/recurrent ITP in our institution. MATERIAL AND METHODS: Clinical and biochemical characteristics, spleen size, indication for surgery, operative time, blood requirements, complications and outcome of 22 patients who underwent laparoscopic splenectomy between 1994 and 1997 were prospectively recorded. Their mean age was 40 +/- 15 (+/- SD), 15 females and 7 males. RESULTS: The preoperative platelet count was 56 thousand +/- 58.7/uL, average spleen size 10.5 +/- 2 cm. The surgical time averaged 4.5 +/- 1 hours; accessory spleens were removed from two patients. Conversion to the open procedure was necessary in two cases. Complete response was achieved in 59%, partial response in 27%, and no response in 14% (none of these due to missed accessory spleens). Six patients developed complications. One of them died two days after surgery. The mean postoperative stay was 4.7 +/- 2.6 days. CONCLUSIONS: The results of laparoscopic splenectomy were similar to our previous results with the open approach. The laparoscopic technique took longer in our hands but the postoperative stay was shorter.
Assuntos
Laparoscopia , Púrpura Trombocitopênica/cirurgia , Esplenectomia , Feminino , Humanos , Laparoscopia/efeitos adversos , Masculino , Estudos Prospectivos , Recidiva , Esplenectomia/efeitos adversos , Resultado do TratamentoAssuntos
Transplante de Rim , Transtornos Linfoproliferativos/fisiopatologia , Complicações Pós-Operatórias , Adolescente , Adulto , Evolução Fatal , Feminino , Humanos , Imunofenotipagem , Sistemas de Informação , Transtornos Linfoproliferativos/epidemiologia , Transtornos Linfoproliferativos/patologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Diarreia/prevenção & controle , Viagem , Países em Desenvolvimento , Diarreia/terapia , Humanos , México , Estados UnidosRESUMO
We report a patient with mixed connective tissue disease (MCTD) who suddenly developed pulmonary distress with bilateral pulmonary infiltrates. She died in 24 h and was found at necropsy to have had a massive alveolar hemorrhage, as well as renal necrotizing vasculitis and immune complex deposits in the glomeruli. One previous case of MCTD with pulmonary hemorrhage was found in the literature. Recognition of this complication of MCTD may help in its early diagnosis.