RESUMO
The occurrence of corneal ectasia after photorefractive keratectomy is a rare but serious complication of refractive surgery. Possible risk factors are not well assessed, but a probable reason is the failure to detect keratoconus preoperatively. In this report, we describe a case of corneal ectasia after photorefractive keratectomy in a patient who presented a suspicious tomography pattern preoperatively but had no degenerative alterations associated with pathologic keratoconus, as revealed by in vivo corneal confocal microscopy. We also review eligible case reports of post-photorefractive keratectomy ectasia to find similar characteristics.
Assuntos
Ceratocone , Ceratectomia Fotorrefrativa , Humanos , Ceratectomia Fotorrefrativa/efeitos adversos , Ceratocone/cirurgia , Ceratocone/complicações , Dilatação Patológica/etiologia , Dilatação Patológica/diagnóstico , Dilatação Patológica/cirurgia , Lasers de Excimer/efeitos adversos , Topografia da Córnea , Acuidade Visual , Microscopia Confocal , Substância Própria/cirurgiaRESUMO
INTRODUCTION: Argon plasma coagulation (APC) alone is effective and safe at treating weight regain following Roux-en-Y gastric bypass (RYGB). However, technical details of the treatment vary widely among studies. Therefore, we aimed to create good clinical practice guidelines through a modified Delphi consensus, including experts from the collaborative Bariatric Endoscopy Brazilian group. METHODS: Forty-one locally renowned experts were invited to the consensus by email. Experiences of > 150 APC-treated cases or authorship of relevant articles were the eligibility criteria. An initial questionnaire with short-answer questions was distributed to the experts. The organizing committee converted the responses into statements for an online 2-day voting webinar. Consensus was defined as more than 67% of positive answers. Three consecutive voting rounds were planned with discussion and statement refinements between rounds. RESULTS: Thirty-seven experts fulfilled eligibility criteria and attended the live webinar voting. The total number of patients treated by the panel was 12,349. By the third round, all 79 statements reached consensus. The recommendations include the definition of dilated gastrojejunal anastomosis as ≥ 15 mm, minimum regain of 20% of the lost weight to indicate the APC therapy, 6 to 8 weeks as the ideal interval between ablation sessions, and stopping treatment when the stoma reaches < 12 mm of breadth. CONCLUSIONS: This consensus provides several recommendations based on a highly experienced panel of endoscopists. Although it covers most aspects of the treatment, the level of evidence is low for the majority of the statements. Therefore, bariatric endoscopists should be constantly attentive to new evidence on APC treatment.
Assuntos
Derivação Gástrica , Obesidade Mórbida , Coagulação com Plasma de Argônio/efeitos adversos , Brasil , Consenso , Técnica Delphi , Dilatação Patológica/cirurgia , Endoscopia Gastrointestinal , Derivação Gástrica/efeitos adversos , Humanos , Obesidade Mórbida/cirurgia , Reoperação , Resultado do Tratamento , Aumento de PesoRESUMO
Introduction: Aortic root dilatation is a frequent disease affecting mostly young patients that often requires surgical repair. Surgical techniques in young patients include aortic valve-sparing procedures to avoid prosthetic valve implant. Objective: The aim of this paper is to describe the results obtained in three patients with aortic root dilatation using the Florida Sleeve technique. Methods: From November 2015 to January 2017, three patients with severe aortic regurgitation due to aortic anuloectasic were intervened applying the Florida Sleeve technique. Results: Excellent postoperative results were obtained in the three cases including freedom of aortic regurgitation and any cause re-operation during three years of follow-up. Conclusion: The Florida Sleeve technique is a safe, reproducible technique with a learning curve and lower surgical times than traditional techniques. The medium-term clinical outcomes in terms of morbidity and mortality are good.
Introducción: La dilatación de la raíz aórtica es una patología frecuente que afecta a pacientes jóvenes y su tratamiento es quirúrgico. Las técnicas quirúrgicas de elección en pacientes jóvenes son las de preservación de la válvula aórtica para evitar el implante de una prótesis valvular. Objetivo: El presente trabajo tiene como objetivo describir la técnica de Florida Sleeve y los resultados de nuestra experiencia. Método: Entre noviembre de 2015 y enero de 2017 fueron intervenidos en nuestro centro tres casos de pacientes con insuficiencia aórtica severa secundaria a anulectasia aórtica en los que se realizó la técnica de Florida Sleeve. Resultados: En los tres casos se obtuvieron excelentes resultados postoperatorios, libres de insuficiencia aórtica residual y de reoperación por cualquier causa, resultados que se mantuvieron a los tres años de seguimiento. Conclusiones: La técnica de Florida Sleeve es una técnica segura, reproducible con una curva de aprendizaje y tiempos quirúrgicos inferiores a las técnicas tradicionales. Los resultados clínicos a medio plazo en términos de morbimortalidad son buenos.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Adulto , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/etiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Dilatação Patológica/patologia , Dilatação Patológica/cirurgia , Humanos , Pessoa de Meia-Idade , Esternotomia , Resultado do TratamentoRESUMO
PURPOSE: To describe outcomes of customized peripheral anterior lamellar keratoplasty (PALK) for late ectasia of the donor-recipient junction after penetrating keratoplasty (PK) for keratoconus. METHODS: This was a single-center, retrospective review of 33 eyes (28 patients) that developed ectasia restricted to the graft-host junction; 17 eyes underwent PALK using lamellar resections of 8- to 11-mm width starting at the external margin of the previous PK and suturing a same-size donor graft (annular or segmental). Five eyes were excluded from analysis because of postoperative complications unrelated to the technique. RESULTS: The average time between PK and diagnosis of secondary ectasia was 28 years (range 9-49 years). Slit-lamp examination showed localized thinning and elongation of the scar at the graft-host junction with well-defined biomicroscopic limits. Preoperatively, the mean keratometric measures were K1: 44.8 ± 4.8 D and K2: 54.1 ± 4.8 D and postoperatively K1: 47.5 ± 3.5 D and K2: 50.8 ± 2.6 D. The mean improvement in corrected visual acuity was 10 lines, and mean cylinder improved from 9.3 ± 2.1 D to 3.3 ± 1.4 D. All cases showed anatomical and refractive improvement. CONCLUSIONS: With long-term follow-up, late post-PK ectasia becomes an increasing problem. PALK can be a successful surgical option to reinforce the ectatic area while preserving a functional clear PK. By adding donor corneal tissue, PALK restores the ectatic area, improves visual acuity, keratometric values, and astigmatism, and preserves the functional graft while avoiding the higher risks of a larger diameter PK.
Assuntos
Córnea/patologia , Ceratocone/cirurgia , Ceratoplastia Penetrante/métodos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/cirurgia , Acuidade Visual , Adolescente , Adulto , Criança , Córnea/cirurgia , Topografia da Córnea , Dilatação Patológica/diagnóstico , Dilatação Patológica/etiologia , Dilatação Patológica/cirurgia , Feminino , Seguimentos , Humanos , Ceratocone/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Anterior spinal artery syndrome, usually resulting in flaccid paraplegia, is a rare but disastrous complication that can occur after surgery of aortic aneurysms and aortic dissections. Spinal cord infarct as the initial clinical presentation of aortic dissection is a very rare finding. CASE REPORT: A 42-year-old male patient who comes to the emergency department due to severe chest pain associated with presyncope and paraplegia of the lower limbs in the context of type A aortic dissection. CONCLUSIONS: Recognizing this atypical clinical presentation of aortic dissection and knowing how to approach it is critical for an early diagnosis and to minimize the risk of spinal cord ischemia during surgery.
ANTECEDENTES: La lesión de la médula espinal, generalmente resultante en paraplejia flácida, es una complicación rara, pero desastrosa, que puede ocurrir tras intervenciones quirúrgicas de aneurismas o disecciones de aorta. La presentación clínica inicial de una disección de aorta como un síndrome de la arteria espinal anterior es un hallazgo muy infrecuente. CASO CLÍNICO: Varón de 42 años que acude al servicio de urgencias hospitalario por dolor torácico intenso asociado a cuadro presincopal y paraplejia de miembros inferiores en el contexto de una disección de aorta tipo A. CONCLUSIONES: Reconocer esta forma de presentación clínica y saber cómo realizar un abordaje adecuado es fundamental para el diagnóstico precoz y para minimizar el riesgo quirúrgico de presentar isquemia medular.
Assuntos
Síndrome da Artéria Espinal Anterior/etiologia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Torácica/complicações , Dissecção Aórtica/complicações , Paraplegia/etiologia , Adulto , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Dor no Peito/etiologia , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Artéria Renal/diagnóstico por imagem , Medula Espinal/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
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
OBJECTIVE: Here we present the first video demonstration of reduction corporoplasty in the management of phallic disfigurement in a 17 year old man with a history sickle cell disease and priapism. INTRODUCTION: Surgical management of aneurysmal dilation of the corpora has yet to be defined in the literature. MATERIALS AND METHODS: We preformed bilateral elliptical incisions over the lateral corpora as management of aneurysmal dilation of the corpora to correct phallic disfigurement. RESULTS: The patient tolerated the procedure well and has resolution of his corporal disfigurement. CONCLUSIONS: Reduction corporoplasty using bilateral lateral elliptical incisions in the management of aneurysmal dilation of the corpora is a safe an feasible operation in the management of phallic disfigurement.
Assuntos
Anemia Falciforme/cirurgia , Pênis/cirurgia , Priapismo/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Aneurisma/cirurgia , Dilatação Patológica/cirurgia , Humanos , Masculino , Resultado do TratamentoRESUMO
Objective Here we present the first video demonstration of reduction corporoplasty in the management of phallic disfigurement in a 17 year old man with a history sickle cell disease and priapism. Introduction Surgical management of aneurysmal dilation of the corpora has yet to be defined in the literature. Materials and Methods: We preformed bilateral elliptical incisions over the lateral corpora as management of aneurysmal dilation of the corpora to correct phallic disfigurement. Results The patient tolerated the procedure well and has resolution of his corporal disfigurement. Conclusions Reduction corporoplasty using bilateral lateral elliptical incisions in the management of aneurysmal dilation of the corpora is a safe an feasible operation in the management of phallic disfigurement. .
Assuntos
Humanos , Masculino , Adolescente , Pênis/cirurgia , Priapismo/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Anemia Falciforme/cirurgia , Resultado do Tratamento , Dilatação Patológica/cirurgia , Aneurisma/cirurgiaRESUMO
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 ProspectivosRESUMO
PURPOSE: To ascertain whether the volume and circumference of the lacrimal sac and nasolacrimal duct as measured by contrast-enhanced computed tomographic dacryocystography (CT-DCG) before and after balloon dacryoplasty could be used to predict clinical success in children with congenital nasolacrimal obstruction. METHODS: Nasolacrimal ducts of children aged 2 to 6 years with clinical signs of congenital nasolacrimal duct obstruction undergoing balloon dilation were imaged with contrast-enhanced CT-DCG before and 5 minutes after the procedure. The circumference of the most dilated portion of the lacrimal sac was measured on the axial plane. The volume of contrast within the nasolacrimal duct and sac was also measured before and after the procedure. Clinical success was defined as the disappearance of signs of epiphora. RESULTS: A total of 18 nasolacrimal ducts of 13 children were included. The average circumference of the most dilated portion of the lacrimal sac was 1.30 ± 0.45 cm (range, 0.64-2.50 cm) before the procedure. The average contrast volume was 0.12 ± 0.08 cm(3) (range, 0.01-0.38 cm(3)) before and 0.07 ± 0.06 cm(3) (range, 0.01-0.20 cm(3)) after (P = 0.01). Data were analyzed using multivariate logistic regression with a backward variable input model; a decrease in contrast volume before and after dilation (P = 0.04) was associated with clinical success, whereas the larger size of the most dilated portion of the lacrimal sac (P = 0.01) was associated with clinical failure. CONCLUSIONS: Contrast-enhanced CT-DCG provides useful information about nasolacrimal anatomy in children with congenital nasolacrimal duct obstruction. The decrease in contrast volume before and after balloon dilation was predictive of success; A larger size of the most dilated portion of the lacrimal sac was associated with clinical failure.