RESUMO
INTRODUCTION: Fifty percent of small bowel bleeding is caused by angioectasia and the rebleeding rate due to small bowel angioectasia (SBA) is 80%. Its endoscopic treatment is difficult. Beneficial effects of octreotide on gastrointestinal angioectasia have been described, but no studies have reported its efficacy in SBA. AIM: Our aim was to investigate the effectiveness of octreotide in the prevention of rebleeding due to SBA. MATERIAL AND METHODS: Sixteen patients with bleeding caused by SBA were assigned to treatment with octreotide 100 µg/24 h SC, for at least 6 months, and compared with a non-treatment group of 36 patients. The primary outcome was the rebleeding rate, and the secondary outcomes were the number of hospital readmissions, bleeding-related death, and adverse effects. RESULTS: Octreotide was administered for 10.5 ± 8.4 months. Follow-up was 12.9 ± 17.3 months and 15.3 ± 17.7 months, in the treatment and non-treatment groups, respectively (p = 0.09). At the end of follow-up, 4 (25%) treatment group patients and 26 (72.2%) non-treatment group patients presented with rebleeding (p = 0.002). In the treatment group and non-treatment group, the cumulative probability of remaining rebleeding-free at one year was 79% vs 44.2%, and 79% vs 34.6% at 2 years, respectively (p = 0.05). Through the multiple logistic regression analysis, treatment was the protective variable. Six patients presented with adverse events. One of those patients (6.25%) had a major adverse event. CONCLUSIONS: Our results suggest that treatment with octreotide could be efficacious in the prevention of rebleeding due to SBA.
Assuntos
Intestino Delgado , Octreotida , Humanos , Octreotida/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Dilatação Patológica/complicaçõesRESUMO
PURPOSE: The aim of this study was to evaluate the performance of the new classification of urinary tract dilatation (UTD) to predict long-term clinical outcomes in infants with isolated antenatal hydronephrosis (ANH). MATERIALS AND METHODS: Between 1989 and 2019, 447 infants diagnosed with isolated severe ANH and were prospectively followed. The main predictive variable for the analysis was the new UTD classification system. The events of interest were surgical interventions, urinary tract infections, chronic kidney disease stage II or higher, hypertension and proteinuria. The primary end-point was time until the occurrence of a composite event of renal injury, including proteinuria, hypertension and chronic kidney disease. RESULTS: Among 447 infants with ANH included in the analysis, 255 (57%) had UTD P1, 93 (20.8%) UTD P2 and 99 (22.2%) UTD P3. Median followup time was 9 years (IQR 7-12 years). Of 447 patients included in the analysis, 11 (2.5%) had hypertension, 13 (2.9%) exhibited persistent mild proteinuria, 14 (3%) developed chronic kidney disease Stage 2 and 26 (5.8%) had the composite outcome of renal injury. By survival analysis, the UTD system predicted accurately all events of interest. According to the Kaplan-Meier survival analysis, the probability of renal injury at 20 years of age was estimated at about 0%, 14% and 56% for patients assigned to UTD P1, UTD P2 and UTD P3, respectively (p <0.001). CONCLUSIONS: Our findings provide insights that the new UTD classification has a good performance for discriminating not only mid-term, but also long-term clinical outcomes, including renal injury.
Assuntos
Dilatação Patológica/classificação , Hidronefrose/classificação , Estudos de Coortes , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Humanos , Hidronefrose/complicações , Hidronefrose/diagnóstico por imagem , Lactente , Recém-Nascido , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia Pré-Natal , Sistema Urinário/diagnóstico por imagemRESUMO
Pancreaticobiliary maljunction (PBM) is associated with high risk of epithelial atypical growth and malignant transformation of the bile duct or gallbladder. However, overall changes in genetic expression have not been examined in children with PBM. Genome-wide expression was analyzed using peripheral blood samples from 10 children with PBM and 15 pediatric controls. Differentially expressed genes (DEGs) were identified using microarray. Bioinformatics analysis was conducted using Gene Ontology and KEGG analyses. The top 5 in the up-regulated genes in PBM were verified with qRT-PCR. Receiver operator characteristic curve analysis was conducted to evaluate the predictive accuracy of selected genes for PBM. The microarray experiments identified a total of 876 DEGs in PBM, among which 530 were up-regulated and the remaining 346 were down-regulated. Verification of the top 5 up-regulated genes (TYMS, MYBPC1, FUT1, XAGE2, and GREB1L) by qRT-PCR confirmed the up-regulation of MYBPC1 and FUT1. Receiver operating characteristic curve analysis suggested that FUT1 and MYBPC1 up-regulation could be used to predict PBM, with the area under the curve of 0.873 (95%CI=0.735-1.000) and 0.960 (95%CI=0.891-1.000), respectively. FUT1 and MYBPC1 were up-regulated in children with PBM, and could be used as potential biomarkers for PBM.
Assuntos
Ductos Biliares/anormalidades , Proteínas de Transporte/genética , Fucosiltransferases/genética , Perfilação da Expressão Gênica , Ductos Pancreáticos/anormalidades , Regulação para Cima/genética , Neoplasias dos Ductos Biliares/etiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Dilatação Patológica/complicações , Dilatação Patológica/congênito , Feminino , Neoplasias da Vesícula Biliar/etiologia , Humanos , Lactente , Masculino , Análise em Microsséries , Galactosídeo 2-alfa-L-FucosiltransferaseRESUMO
Pancreaticobiliary maljunction (PBM) is associated with high risk of epithelial atypical growth and malignant transformation of the bile duct or gallbladder. However, overall changes in genetic expression have not been examined in children with PBM. Genome-wide expression was analyzed using peripheral blood samples from 10 children with PBM and 15 pediatric controls. Differentially expressed genes (DEGs) were identified using microarray. Bioinformatics analysis was conducted using Gene Ontology and KEGG analyses. The top 5 in the up-regulated genes in PBM were verified with qRT-PCR. Receiver operator characteristic curve analysis was conducted to evaluate the predictive accuracy of selected genes for PBM. The microarray experiments identified a total of 876 DEGs in PBM, among which 530 were up-regulated and the remaining 346 were down-regulated. Verification of the top 5 up-regulated genes (TYMS, MYBPC1, FUT1, XAGE2, and GREB1L) by qRT-PCR confirmed the up-regulation of MYBPC1 and FUT1. Receiver operating characteristic curve analysis suggested that FUT1 and MYBPC1 up-regulation could be used to predict PBM, with the area under the curve of 0.873 (95%CI=0.735−1.000) and 0.960 (95%CI=0.891−1.000), respectively. FUT1 and MYBPC1 were up-regulated in children with PBM, and could be used as potential biomarkers for PBM.
Assuntos
Humanos , Masculino , Lactente , Pré-Escolar , Criança , Ductos Pancreáticos/anormalidades , Ductos Biliares/anormalidades , Regulação para Cima/genética , Perfilação da Expressão Gênica , Fucosiltransferases/genética , Neoplasias dos Ductos Biliares/etiologia , Proteínas de Transporte/genética , Estudos de Casos e Controles , Análise em Microsséries , Dilatação Patológica/complicações , Dilatação Patológica/congênito , Neoplasias da Vesícula Biliar/etiologiaRESUMO
BACKGROUND: An alternative treatment for obstructive and refluxing obstructive megaureter with ureterovesical junction maintenance through laparoscopy is proposed. MATERIAL AND METHODS: The series consists of 8 cases, all of them studied because of prenatal hydronephrosis or febrile urinary tract infection. Seven were diagnosed with obstructive megaureter and one with obstructive refluxing megaureter. The procedure consisted in incising the stenotic portion of the ureter longitudinally and maintaining its posterior wall attached to the bladder, the anterior wall of the ureter was anastomosed transversally to the bladder mucosa in order to liberate the obstruction. RESULTS: Two of the 8 cases were women and 6 were male. They were aged between 5 months and 11 years (average age of 2.9 years). The surgical time varied between 90 and 120min, with a 48h hospital stay. The permanence of the vesical catheter and the double J stent was of 48h and 6 weeks, respectively. A female patient developed febrile urinary tract infection one week after the surgical procedure. The rest of the patients remained asymptomatic, with normal urinalysis and quarterly urine culture results. Six months after the procedure, the ultrasound showed improvement of the ureteral diameter and of the pyelocaliceal ectasia. The average follow-up was of 2 years. DISCUSSION: The handling of stenosis with longitudinal incision of the ureter and transverse anastomosis to the bladder mucosa, seems promising. The laparoscopic approach allows to identify clearly the longitude of the stenotic segment and join with relative precision such opening with the one of the vesical mucosa.
Assuntos
Laparoscopia/métodos , Ureter/cirurgia , Obstrução Ureteral/cirurgia , Bexiga Urinária/cirurgia , Refluxo Vesicoureteral/complicações , Anastomose Cirúrgica/métodos , Criança , Pré-Escolar , Dilatação Patológica/complicações , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Hidronefrose/complicações , Hidronefrose/embriologia , Lactente , Masculino , Stents , Técnicas de Sutura , Ureter/anormalidades , Obstrução Ureteral/etiologia , Cateterismo Urinário , Infecções Urinárias/complicaçõesRESUMO
A dilatação-vólvulo gástrica é comum em raças grandes de tórax profundo. Alterações como hipomotilidade podem gerar dilatação gástrica e sucessivas dilatações subclínicas podem levar a dilatação-vólvulo gástrica pelo esgarçamento dos ligamentos gástricos. O tratamento de eleição, após estabilização do paciente, é o reposicionamento e gastropexia. Dentre as várias técnicas existentes, a gastropexia incisional é de rápida execução e suas taxas de recidiva são baixas. Neste trabalho relatamos o caso de uma cadela de raça Mastiff Inglês com recidiva de dilatação-vólvulo gástrica 3 meses após gastropexia incisional.(AU)
The gastric dilatation-volvulus is common in large-breed deep-chested dogs. Changes in gastrointestinal motility can lead to gastric dilatation and successive subclinical gastric dilatation can lead to a gastric dilatation-volvulus by the stretching of gastric ligament. The treatment of choice, after the patient in clinically stabilized, is the reposition of the stomach to its normal position followed by pyloric gastropexy. Among the various existents techniques, the incisional gastropexy has the fastest execution with lower recurrence rates. In this study we report a recurrence gastric dilatation-volvulus in a English Mastiff bitch three months after a pyloric incisional gastropexy.(AU)
La dilatación-vólvulo gástrica es común en perros de razas grandes de tórax profundo. Alteraciones como hipomotilidad pueden generar dilatación gástrica, y sucesivas dilataciones subclínicas pueden llevar a la dilatación-vólvulo gástrica por el estiramiento de los ligamentos gástricos. El tratamiento de elección, después dela estabilización dei paciente, es el reposicionamiento y la gastropexia. Entre las varias técnicas existentes, la gastropexia incisional es de rápida ejecución y sus tasas de recaída son bajas. En este trabajo informamos el caso de una perra de raza Mastín Inglés con recaída de dilatación-vólvulo gástrica 3 meses después de gastropexia incisional.(AU)
Assuntos
Animais , Cães , Recidiva , Gastropexia/veterinária , Dilatação Patológica/complicações , Dilatação Patológica/veterinária , Volvo Intestinal/patologia , Volvo Intestinal/veterinária , Procedimentos Cirúrgicos Operatórios/veterinária , Sistema Digestório/patologiaRESUMO
A dilatação-vólvulo gástrica é comum em raças grandes de tórax profundo. Alterações como hipomotilidade podem gerar dilatação gástrica e sucessivas dilatações subclínicas podem levar a dilatação-vólvulo gástrica pelo esgarçamento dos ligamentos gástricos. O tratamento de eleição, após estabilização do paciente, é o reposicionamento e gastropexia. Dentre as várias técnicas existentes, a gastropexia incisional é de rápida execução e suas taxas de recidiva são baixas. Neste trabalho relatamos o caso de uma cadela de raça Mastiff Inglês com recidiva de dilatação-vólvulo gástrica 3 meses após gastropexia incisional.
The gastric dilatation-volvulus is common in large-breed deep-chested dogs. Changes in gastrointestinal motility can lead to gastric dilatation and successive subclinical gastric dilatation can lead to a gastric dilatation-volvulus by the stretching of gastric ligament. The treatment of choice, after the patient in clinically stabilized, is the reposition of the stomach to its normal position followed by pyloric gastropexy. Among the various existents techniques, the incisional gastropexy has the fastest execution with lower recurrence rates. In this study we report a recurrence gastric dilatation-volvulus in a English Mastiff bitch three months after a pyloric incisional gastropexy.
La dilatación-vólvulo gástrica es común en perros de razas grandes de tórax profundo. Alteraciones como hipomotilidad pueden generar dilatación gástrica, y sucesivas dilataciones subclínicas pueden llevar a la dilatación-vólvulo gástrica por el estiramiento de los ligamentos gástricos. El tratamiento de elección, después dela estabilización dei paciente, es el reposicionamiento y la gastropexia. Entre las varias técnicas existentes, la gastropexia incisional es de rápida ejecución y sus tasas de recaída son bajas. En este trabajo informamos el caso de una perra de raza Mastín Inglés con recaída de dilatación-vólvulo gástrica 3 meses después de gastropexia incisional.
Assuntos
Animais , Cães , Dilatação Patológica/complicações , Dilatação Patológica/veterinária , Gastropexia/veterinária , Recidiva , Volvo Intestinal/patologia , Volvo Intestinal/veterinária , Procedimentos Cirúrgicos Operatórios/veterinária , Sistema Digestório/patologiaRESUMO
Introducción: La coronarioectasia (CE), es una infrecuente forma de enfermedad coronaria, en que dilataciones coronarias coexisten con placas ateroes-cleróticas. Puede presentarse como cuadros agudos o crónicos, aún sin estenosis significativa. Distintas series lo han asociado a perfiles variados de factores de riesgo cardiovascular. Métodos: Se efectuó un estudio analítico de cohorte retrospectivo, evaluando las coronariografías realizadas en nuestro centro entre Junio de 2009 a Julio de 2015. Se definió CE como dilatación >1,5 veces comparado con el diámetro de la arteria de referencia. Se estudiaron factores de riesgo cardiovascular clásicos y se compararon con un grupo control elegido de forma aleatoria. Resultados: De 9648 coronariografías, 64 presentaban CE. La mayor parte eran hombres, de menor edad, con menos hipertensión arterial, diabetes e hiperlipidemia, comparados con los controles. En la mayoría de los casos la CE afectaba a 3 vasos (83,3%) y en solo 5 casos (28%) coexistía con estenosis. El análisis multivariado señaló como factores de riesgo significativos a la edad < 55 años (OR: 2,63, IC: 1,4 -4,9, p<0,05), Obesidad (OR: 3,2; IC:1,7-5,8, p<0,05) e Hiperlipidemia (OR: 0,09; IC: 0,016-0,54). Considerando los pacientes que se presentaron como SCA se observó que los pacientes con CE fueron más jóvenes (45,9 años; DE: 5,9 v/s 48,8 años; DE: 5,3; p=0,02), y con menos hiperlipidemia (OR:0,2; IC:0,06-0,7, p=0,01). Respecto a la obesidad, esta fue más preva-lente en pacientes con CE (OR: 2,49; IC: 0,956-6,4. p=ns). Conclusión: La CE es una entidad poco frecuente, que puede producir SCA aun en ausencia de estenosis significativa. Son pacientes más jóvenes y con menos antecedente de dislipidemia, por lo que en su patogenia aparentemente participan factores diferentes a los de la enfermedad ateroesclerótica obstructiva.
Background: Coronary ectasia (CE) is an uncommon condition where coronary artery dilatation coexists with atherosclerotic plaques. It may present as either acute or chronic syndromes even in the absence of coronary artery stenosis. Differences in risk factors associated to CE compared to those associated to usual CAD have been described. Methods: We retrospectively analyzed coronary arteriograms performed between June 2009 and July 2015. CE was defined as the presence of dilatation >1.5 times the diameter of the unaffected vessel. Cardiovascular risk factors were compared in CE vs a random sample of non-CE patients. Results: Out of 9648 coronary arteriograms 64 showed CE (9.5%). Compared to controls, CE patients were males, younger and hat lower prevalence or hypertension, diabetes and hyperlipidemia. CE was present in all 3 main vessels in 83.3% of CE patients and co-existed with significant stenosis in only 28%. Multivariate analysis showed that significant differences in risk factors were age <55 years (OR: 2.63; CI: 1.4 to 4.9, p <0.05), obesity (OR: 3 2; CI: 1.7 to 5.8, p <0.05) and hyperlipidemia (OR: 0.09; CI: 0.016 to 0.54). In patients presenting with an acute coronary syndrome, those with CE were younger (45,9 years; SD: 5,9 v/s 48,8 years; SD: 5,3; p=0,02), y and a lower prevalence or hyperlipidemia (OR:0,2; IC:0,06-0,7, p=0,01). Conclusion: CE is an infrequent condition in CAD. It may me associated to either acute or chronic syndromes. They are younger, have a lower prevalence of dyslipidemia suggesting that risk factors other than traditionally recognized in obstructive CAD influence de development of CE.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Doença da Artéria Coronariana/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Síndrome Coronariana Aguda , Prognóstico , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Angiografia Coronária , Medição de Risco , Dilatação Patológica/complicações , Aterosclerose/complicações , Estudo ObservacionalRESUMO
INTRODUCTION: Anecdotal reports have demonstrated the feasibility of needle aspiration to deflate a distended bowel, but we do not know of any prospective study that has evaluated this technique. We designed a controlled study to evaluate the use of the selective transperitoneal needle aspiration of a bowel loop (STAB) in infants. MATERIALS AND METHODS: Candidates were patients of less than 6 months of age, scheduled for laparoscopic Nissen fundoplication, in whom severe colonic distension was observed. We randomized the patients to the study drug or placebo in a 1:1 mode. The treatment group received STAB, whereas the control group was subject to conventional maneuvers. We performed 403 Nissen procedures laparoscopically: 102 were in infants ≤ 6 months old, but only 44 presented severe transverse colonic distension. RESULTS: STAB facilitated the surgical procedure and drastically reduced surgical time. Thus, we calculated our sample size with use of the following inputs: 90% power, a critical P value of .05, and 50% reduction in surgical time. This resulted in a necessary sample size of 21 subjects per group, for a total required sample size of 42 subjects. STAB procedures were done in 23 patients, and conventional measures were used in 21. STAB was attempted a total of 45 times. Mean operative time was shorter in the STAB group. CONCLUSIONS: We propose the use of STAB as alternative therapy to decompress a dilated large-bowel loop during laparoscopic surgery. This maneuver is simple and efficient and has no clinical complications. Future studies are required to evaluate its role in the subset of other patients or procedures.
Assuntos
Colo/cirurgia , Doenças do Colo/cirurgia , Fundoplicatura/métodos , Refluxo Gastroesofágico/cirurgia , Agulhas , Punções/métodos , Doenças do Colo/complicações , Dilatação Patológica/complicações , Dilatação Patológica/cirurgia , Feminino , Refluxo Gastroesofágico/complicações , Humanos , Lactente , Recém-Nascido , Laparoscopia/métodos , Masculino , Duração da Cirurgia , Estudos ProspectivosAssuntos
Hemorragia Gastrointestinal/etiologia , Doenças do Íleo/etiologia , Doenças do Jejuno/etiologia , Malformações Vasculares/complicações , Idoso , Idoso de 80 Anos ou mais , Endoscopia por Cápsula , Dilatação Patológica/complicações , Feminino , Humanos , Íleo/irrigação sanguínea , Jejuno/irrigação sanguínea , Masculino , Malformações Vasculares/diagnósticoRESUMO
La cavernomatosis portal es una patología poco frecuente causada por la trombosis de la vena porta. Es la principal causa de hipertensión portal en niños. La causa muchas veces no se identifica, pudiendo reconocerse factores predisponentes, entre los cuales los más frecuentes son el cateterismo de la vena umbilical y la onfalitis. Se manifiesta a través de sus complicaciones: hemorragia digestiva alta por várices esofágicas y esplenomegalia. El diagnóstico se confirma con ecografía abdominalcon Doppler. La terapéutica incluye el tratamiento médico-endoscópico de las várices esofágicas. La derivación quirúrgica porto-sistémica resuelve la obstrucción portal. Se realizó un estudio retrospectivo con el objetivo de describir las características clínicas de pacientes con cavernomatosis portal en el período enero de 1999 a abril de 2009 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Se identificaron ocho pacientes, con una media de edad al momento del diagnóstico de 2 años y 2 meses. La forma de presentación más frecuente fue la hematemesis. En la mayoría se constató esplenomegalia. En tres se identificaron factores predisponentes: cateterismo umbilical, cirugía abdominal. Todos tenían várices esofágicas al diagnóstico. Tres pacientes reiteraron hemorragia digestiva alta, uno en tres y otro en cuatro oportunidades. Cuatro pacientes requirieron escleroterapia o banding por sus várices esofágicas. Un paciente recibió cirugía derivativa. Esta patología no tuvo, en este período de tiempo, una alta prevalencia, pero alta morbilidad. Todos eran pequeños, la mayoría sin factores de riesgo y se presentaron a través de complicaciones de la enfermedad. La mayoría reiteró complicaciones en la evolución.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Dilatação Patológica/complicações , Hemangioma Cavernoso/complicações , Hipertensão Portal/etiologia , Veia Porta/anormalidades , Veia Porta/fisiopatologiaRESUMO
La cavernomatosis portal es una patología poco frecuente causada por la trombosis de la vena porta. Es la principal causa de hipertensión portal en niños. La causa muchas veces no se identifica, pudiendo reconocerse factores predisponentes, entre los cuales los más frecuentes son el cateterismo de la vena umbilical y la onfalitis. Se manifiesta a través de sus complicaciones: hemorragia digestiva alta por várices esofágicas y esplenomegalia. El diagnóstico se confirma con ecografía abdominalcon Doppler. La terapéutica incluye el tratamiento médico-endoscópico de las várices esofágicas. La derivación quirúrgica porto-sistémica resuelve la obstrucción portal. Se realizó un estudio retrospectivo con el objetivo de describir las características clínicas de pacientes con cavernomatosis portal en el período enero de 1999 a abril de 2009 en el Hospital Pediátrico del Centro Hospitalario Pereira Rossell (HP-CHPR). Se identificaron ocho pacientes, con una media de edad al momento del diagnóstico de 2 años y 2 meses. La forma de presentación más frecuente fue la hematemesis. En la mayoría se constató esplenomegalia. En tres se identificaron factores predisponentes: cateterismo umbilical, cirugía abdominal. Todos tenían várices esofágicas al diagnóstico. Tres pacientes reiteraron hemorragia digestiva alta, uno en tres y otro en cuatro oportunidades. Cuatro pacientes requirieron escleroterapia o banding por sus várices esofágicas. Un paciente recibió cirugía derivativa. Esta patología no tuvo, en este período de tiempo, una alta prevalencia, pero alta morbilidad. Todos eran pequeños, la mayoría sin factores de riesgo y se presentaron a través de complicaciones de la enfermedad. La mayoría reiteró complicaciones en la evolución.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Dilatação Patológica/complicações , Hemangioma Cavernoso/complicações , Veia Porta/anormalidades , Veia Porta/fisiopatologia , Hipertensão Portal/etiologiaAssuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Dilatação Patológica/complicações , Doenças Vasculares Periféricas/patologia , Extremidade Inferior/irrigação sanguínea , Flebite/etiologia , Pressão Venosa/fisiologia , Tromboembolia Venosa/patologia , Veia Safena/cirurgia , Fator VIII , Síndrome de Behçet/patologia , Tecido Elástico/citologia , Varizes/patologiaRESUMO
OBJECTIVES: This study was designed to evaluate bowel diameter as a predictor of adverse outcome in isolated fetal gastroschisis. METHODS: Retrospective study involving 94 singleton pregnancies. Ultrasound measurements of herniated bowel transverse diameter (BTD) were performed up to 3 weeks before delivery. Adverse outcome was intrauterine/neonatal death and/or bowel complications. RESULTS: Last BTD was recorded at 35.6 ± 1.6 weeks and mean interval to delivery was 6.2 ± 5.0 days. Intrauterine/neonatal death occurred in 10 (10.6%) cases; bowel complications were observed in 8 (8.5%). BTD ≥ 15, ≥ 20, ≥ 25, and ≥ 30 mm were found in 87, 46, 13, and 4% of pregnancies with a favorable outcome, respectively. BTD ≥ 25 mm sensitivity was 38%, and positive and negative predictive values were 38 and 87%. For BTD ≥ 30 mm, the values were 19, 50, and 85%. Observed/expected BTD ROC curve showed an area of 0.67, best cut-off value at 1.39; prediction values were similar to those for BTD ≥ 25 mm. Bowel dilatation was also significantly associated with lower rate of primary surgical closure, longer period to full oral feeding, and prolonged hospital stay. CONCLUSIONS: Bowel dilatation demonstrated up to 3 weeks before delivery is a predictor of intestinal complications and is associated with lower rate of primary surgical closure, longer period to achieve full oral feeding, and hospital stay.
Assuntos
Gastrosquise/patologia , Enteropatias/patologia , Intestinos/patologia , Ultrassonografia Pré-Natal , Brasil/epidemiologia , Dilatação Patológica/complicações , Dilatação Patológica/epidemiologia , Dilatação Patológica/patologia , Morte Fetal/epidemiologia , Gastrosquise/complicações , Gastrosquise/epidemiologia , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Enteropatias/epidemiologia , Enteropatias/etiologia , Intestinos/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Estudos RetrospectivosRESUMO
Laryngoceles are abnormal dilatations of the laryngeal saccule, which rises between the ventricular folds, the base of the epiglottis and the inner surface of the thyroid cartilage. Clinical symptoms are rare, and the find of asymptomatic laryngoceles in pathology studies are frequent. Sometimes it is presented as cervical swelling causing airway obstruction in need of emergency intervention. In this study, we report a case of upper airway obstruction due to laryngocele treated by emergency tracheotomy and we review of the literature. Laryngocele complications include infection (pyocele formation), pathogens aspirations with subsequent bronchitis and pneumonia and upper airway obstruction, as in the case reported. Despite being benign tumors, laryngoceles cause relevant airway obstruction. Correct diagnosis and proper treatment can preclude emergencies as it happened to our patient hereby reported.
Assuntos
Obstrução das Vias Respiratórias/etiologia , Doenças da Laringe/complicações , Obstrução das Vias Respiratórias/cirurgia , Dilatação Patológica/complicações , Dilatação Patológica/cirurgia , Feminino , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Laringe/patologia , Pessoa de Meia-Idade , TraqueotomiaRESUMO
Laringoceles são dilatações anormais do sáculo do ventrículo de Morgani da laringe, localizando-se entre a falsa prega vocal e a face interna da cartilagem tireóide. Relevância clínica é rara, sendo o achado de laringoceles assintomáticas em necropsia muito alto. Algumas vezes, pode se apresentar já como uma grande massa cervical, levando à obstrução de vias aéreas e necessitando de intervenção de urgência. Neste trabalho, os autores relatam um caso de laringocele levando à obstrução de vias aéreas superiores, necessitando de traqueostomia de urgência e fazem uma revisão da literatura sobre o tema. Complicações de laringocele incluem infecção (formação de piocele), aspiração de patógenos e subseqüente bronquite e pneumonia, infecção do espaço lateral da faringe (depois de ruptura) e obstrução de vias aéreas superiores, como no caso apresentado. A laringocele, apesar de ser uma doença benigna, é uma causa potencial de obstrução respiratória que pode ameaçar a vida do paciente. O correto diagnóstico e manejo adequado precoce podem evitar que situações de emergência, como a do paciente do caso relatado, levem à morte.
Laryngoceles are abnormal dilatations of the laryngeal saccule, which rises between the ventricular folds, the base of the epiglottis and the inner surface of the thyroid cartilage. Clinical symptoms are rare, and the find of asymptomatic laryngoceles in pathology studies are frequent. Sometimes it is presented as cervical swelling causing airway obstruction in need of emergency intervention. In this study, we report a case of upper airway obstruction due to laryngocele treated by emergency tracheotomy and we review of the literature. Laryngocele complications include infection (pyocele formation), pathogens aspirations with subsequent bronchitis and pneumonia and upper airway obstruction, as in the case reported. Despite being benign tumors, laryngoceles cause relevant airway obstruction. Correct diagnosis and proper treatment can preclude emergencies as it happened to our patient hereby reported.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Obstrução das Vias Respiratórias/etiologia , Doenças da Laringe/complicações , Obstrução das Vias Respiratórias/cirurgia , Dilatação Patológica/complicações , Dilatação Patológica/cirurgia , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Laringe/patologia , TraqueotomiaRESUMO
Urofacial syndrome was described by Elejade in 1979, who coined the term "Ochoa's Syndrome". It includes abnormal micturition, upper urinary tract dilatation, constipation and facial peculiar expression while smiling. In 1995, 3 boys with 2, 7 and 9 years old, come to the La Plata Children's Hospital, affected for this syndrome, with young, normal and no consanguinity parents. Clean intermittent catheterization was indicated in all cases, with oxibutinin in one of them, with enuresis in all the cases and normal serum creatinine for three years, when discontinued the follow-up. This cases been demonstrated the genetic condition of this syndrome, because there were 3 brothers in different steps of this condition, with the same age of initiation and progression We describe the three first cases in Argentine
Assuntos
Constipação Intestinal/complicações , Fácies , Bexiga Urinaria Neurogênica/complicações , Sistema Urinário/anormalidades , Argentina , Criança , Pré-Escolar , Dilatação Patológica/complicações , Humanos , Masculino , SíndromeRESUMO
The article describes a woman with 53 year-old that has presented diplopia when looking down and adopted a tilted head position in order to read for the last six months. The neuro-ophthalmic examination shows isolated right superior oblique muscle paresis. The magnetic resonance and the angioresonance show the dolicoectatic basilar artery compressing the right ventral lateral brainstem.
Assuntos
Doenças do Nervo Oculomotor/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico , Constrição Patológica/etiologia , Dilatação Patológica/complicações , Diplopia/diagnóstico , Diplopia/etiologia , Feminino , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/etiologia , Tomografia Computadorizada por Raios X , Insuficiência Vertebrobasilar/complicaçõesRESUMO
We report the case of an adolescent referred with initial diagnosis of pulmonary hypertension. Non-invasive investigation disclosed a sinus venous atrial septal defect with pulmonary hypertension. The hemodynamic study confirmed diagnosis, and also showed extrinsic compression of left main coronary artery by pulmonary trunk. Surgical closure of the defect in addition to pulmonary trunk plasty were undertaken. Two years after the surgery the patient is well, with clinical signs of mild pulmonary hypertension, and showing no evidence--also on echocardiogram--of left coronary artery trunk obstruction.