prevent complications

  • 文章类型: Case Reports
    子宫平滑肌瘤(ULs)是常见的良性肿瘤,在很大一部分女性中可以根据其在子宫内的位置进行分类。它们可以引起许多骨盆并发症,并且可以进行医学管理,但更常见的是手术。子宫肌瘤常发生在产后,可能是梗塞,并可能导致变性和败血症。我们的病人出现了两个月的潜在化脓性肌瘤,最初在计算机断层扫描(CT)上发现。办公室检查显示子宫颈有突出的肿块,并尝试切除,但最终因疼痛而推迟进行全身麻醉检查。切除平滑肌瘤并显示坏死。化脓性肌瘤通常是阴险的,并且通常可以模仿其他有关的病理。现代成像可以显示骨盆内的病变,但难以在液体收集和可能的梗塞肿块之间进行确定。在这种情况下,质量护理措施的重要性值得强调,以防止严重的并发症。
    Uterine leiomyomas (ULs) are common benign tumors seen in a large percent of women that can be classified based on their location within the uterus. They can cause a number of pelvic complications and can be managed medically, but more often surgically. Uterine pyomyomas often occur postpartum, possibly from infarction, and can lead to degeneration and sepsis. Our patient presents with a two-month development of a potential pyomyoma, found initially on computed tomography (CT). Office exam reveals a protruding mass from the cervical os, and removal was attempted but ultimately postponed for general anesthesia exam due to pain. The leiomyoma was removed and shown to be necrosing. Pyomyomas are often insidious and can often mimic other concerning pathologies. Modern imaging can show lesions within the pelvis but struggle to determine between fluid collection and possible infarcted masses. The importance of quality care measures in cases like this deserve to be emphasized to prevent serious complications.
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  • 文章类型: Case Reports
    我们介绍了一名25岁的非洲裔美国女性患者(G1P0)的病例,该患者具有脑动静脉畸形修复的既往病史,肺炎,和尿路感染,在39周时因自发阴道分娩4.025kg女婴而入院分娩。在产后即刻(PP)期间,患者出现严重的盆腔疼痛和行走困难。开始口服非麻醉性镇痛药的保守治疗,直到诊断出PP耻骨联合分离(PSD)。由于盆腔疼痛的持续存在,患者接受了耻骨联合联合类固醇注射,并在第8天出院。出院后24小时内,患者因剧烈疼痛和无法行走而再次进入急诊科.她的疼痛得到了静脉麻醉药和非甾体抗炎药的保守治疗,这很快就消除了疼痛。一旦她报告疼痛改善,她就被观察并出院了,五天后,她在产科医生的诊所接受了重新评估。在诊所里,该患者在耻骨联合区域表现出轻度压痛,但表现出止痛步态改善,能够毫无困难地行走和排尿。尽管缺乏后续成像,让患者放心,PSD和相关压痛应在3~4个月内完全缓解.
    We present the case of a 25-year-old African American female patient (G1P0) with a past medical history of brain arteriovenous malformation repair, pneumonia, and a urinary tract infection who was admitted to the labor and delivery floor at 39 weeks for a spontaneous vaginal delivery of a 4.025 kg female baby. In the immediate postpartum (PP) period, the patient presented with severe pelvic pain and trouble ambulating. Conservative management of oral non-narcotic analgesics was initiated until the diagnosis of PP pubic symphysis diastasis (PSD) was made. Due to the persistence of pelvic pain, the patient underwent a pubic symphysis joint steroid injection and was discharged on day 8. Within 24 hours of discharge, the patient was readmitted to the emergency department with severe pain and an inability to walk. Her pain was managed conservatively with intravenous narcotics and non-steroidal anti-inflammatories, which quickly dissipated the pain. She was observed and discharged once she reported improvement in pain, and she was reassessed five days later at her obstetrician\'s clinic. In the clinic, the patient presented with mild tenderness in the pubic symphysis region but demonstrated improvement in her antalgic gait with an ability to walk and urinate without difficulty. Despite a lack of follow-up imaging, the patient was reassured that her PSD and associated tenderness should completely resolve within three to four months.
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  • 文章类型: Case Reports
    肾切除术,涉及部分或完全切除一个或两个肾脏的手术方法,如果存在肿瘤或许多其他原因,则执行。在上述情况下,一名60岁的女性患者,有反复发作的症状史,胃痛,发烧,以及以前的结核病史被带到三级护理医院。患者接受了左侧肾切除术。在研究过程中进行了X射线和全血细胞计数(CBC)。患者经历了各种术后并发症,如呼吸不适,分泌物,早期疲劳,和重症监护病房获得性弱点(ICUAW)。患者被转诊接受物理治疗。在整个干预过程中,结局评估显示肺活量逐渐改善,吸气压力,和生活质量分数。根据患者症状的严重程度计划以目标为导向的物理治疗。上述病例的物理治疗康复计划计划为期六周,重点关注呼吸急促等症状,早期疲劳,分泌物,呼吸不适,由于切口部位疼痛而难以保持良好的姿势,流动性降低,以及各种术后并发症。该研究的重点是综合理疗策略在增加肺顺应性方面的功效,分泌清除,和整体呼吸健康。早期动员策略对于减少术后问题至关重要,加快功能恢复,缩短住院时间。
    Nephrectomy, a surgical method involving the partial or complete removal of one or both kidneys, is performed if there is the presence of a tumor or many other reasons. In the above case, a 60-year-old female patient with a history of recurring symptoms, stomach pain, and fever, as well as a previous history of tuberculosis was brought to a tertiary care hospital. The patient underwent a left-sided nephrectomy. An X-ray and a complete blood count (CBC) were done during the investigations. Patients experienced various post-operative complications like respiratory discomfort, secretions, early fatigue, and intensive care unit-acquired weakness (ICUAW). The patient was referred for physiotherapy. Throughout the intervention, outcome assessments showed progressive improvement in lung capacity, inspiratory pressure, and quality of life scores. Goal-oriented physiotherapy was planned according to the severity of the symptoms of the patient. The physical therapy rehabilitation program in the above case was planned for six weeks focusing on symptoms like shortness of breath, early fatigue, secretions, respiratory discomfort, difficulty in maintaining good posture because of pain at the incision site, reduced mobility, and various post-operative complications. The study focuses on the efficacy of an integrated physiotherapy strategy in increasing lung compliance, secretion clearance, and overall respiratory health. Early mobilization strategies were crucial in reducing post-surgery problems, hastening functional recovery, and shortening hospital stays.
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  • 文章类型: Journal Article
    我们介绍了一种新的手术技术来解剖喉返神经附近的淋巴结,称为“天然组织保存”技术。使用这种技术,喉返神经没有损伤,它保持在它的解剖位置。
    2016年9月至2018年12月,对87例食管癌患者进行左外侧卧位微创食管癌切除术。喉返神经周围淋巴结清扫术采用天然组织保存技术,对所有患者进行喉返神经麻痹评估。
    所有患者均完成了微创食管切除术,没有转换为开胸手术。尽管所有患者都进行了扩大淋巴结清扫术,没有II级或更高的并发症(Clavien-Dindo分类),也没有喉返神经麻痹的发生率.
    天然组织保存技术可降低微创食管癌根治术后喉返神经麻痹的发生率。
    We introduce a novel operative technique to dissect lymph nodes adjacent to the recurrent laryngeal nerve, referred to as the \"native tissue preservation\" technique. Using this technique, there was no damage to the recurrent laryngeal nerve, which is maintained in its anatomical position.
    From September 2016 to December 2018, minimally invasive esophagectomy was performed in the left lateral decubitus position in 87 patients with esophageal cancer. The native tissue preservation technique for lymphadenectomy around the recurrent laryngeal nerve was used, and all patients were evaluated for recurrent laryngeal nerve paralysis.
    Minimally invasive esophagectomy was completed in all patients without conversion to thoracotomy. Although an extended lymphadenectomy was performed in all patients, there were no grade II or higher complications (Clavien-Dindo classification) and no incidence of recurrent laryngeal nerve paralysis.
    The native tissue preservation technique may reduce the incidence of recurrent laryngeal nerve paralysis after minimally invasive esophagectomy with radical lymph node dissection.
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