A pielonefrite enfisematosa é uma entidade pouco frequente e potencialmente fatal. O reconhecimento desta patologia permite a correta orientação precoce dos doentes. A diabetes e a obstrução ureteral são os principais fatores de risco identificados. Apresenta-se o caso de uma doente saudável, sem fatores de risco conhecidos, em que o motivo de ida ao serviço de urgência foi apenas uma dor lombar, acabando por evoluir com quadro de choque séptico nas primeiras horas. Os exames imagiológicos permitiram identificar a presença de gás perirrenal e subcutâneo o que orientou o correto diagnóstico (pielonefrite enfisematosa secundária a neoplasia urotelial fistulizada) e tratamento cirúrgico. Contudo, e como o estado clínico e analítico à admissão e no pós-operatório faziam prever a doente acabou por falecer. De referir ainda que este mesmo caso documenta uma bacteriemia por Sphingomonas paucimobilis (adquirida na comunidade) com lesões cavitadas a nível pulmonar (provável embolismo séptico).
To study whether there are factors related to secondary diagnoses (SDg) present in patients with prostate cancer that influence the development of urinary incontinence after radical prostatectomy (RP).A retrospective multicenter observational study was performed reviewing the medical records of 430 men who underwent RP due to organ-confined prostate cancer in 9 different hospitals. Two study groups were distinguished: Group A (GA): Patients without urinary incontinence after RP; Group B (GB): patients with any degree of post-surgical urinary incontinence.Average age at surgery was 63.42 years (range 45-73). 258 patients were continent after surgery and 172 patients complaint of any degree of incontinence after RP. A higher percentage of healthy patients was found in group A (continent after surgery) than in group B (p = 0.001). The most common SDg prior to surgery were hypertension, lower urinary tract symptoms, dyslipidemia, diabetes mellitus and erectile dysfunction, but none did show a greater trend towards post-surgical incontinence.A better health status prior to surgery is associated to a lower incidence of new-onset urinary incontinence after radical prostatectomy. However, no correlation was found between the most common medical disorders and the development of post-surgical urinary incontinence.
Background: The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced tibial shaft fractures with intact fibula in children after nonoperative management and operative treatment by elastic stable intramedullary nailing. Methods: A study was performed on 80 consecutive children, 56 males, 24 females from 2 Institutions, with displaced and closed tibial shaft fracture with intact fibula. All patients underwent regular clinical and radiographic follow-up visits for at least 2 years after injury. Results: In total, 26 patients (group A-Institution I) were treated surgically by elastic stable intramedullary nailing and 54 patients (18 patients from group B-Institution I and 36 patients from group C-Institution II) were treated nonoperatively with closed reduction and casting. groups A, B, and C did not significantly differ on sex ( P =0.37), side ( P =0.54), and fracture site ( P =0.14). Valgus deformity was significantly controlled in group A patients only ( P =0.001); during follow-up in group B patients ( P =0.017), and showed no significant change between pretreatment images and last follow-up in group C patients ( P =0.71). Procurvatum deformity was significantly controlled in group A patients only ( P =0.001); it showed no significant improvement after conservative treatment in group B ( P =0.73) and C patients ( P =0.8). Recurvatum was significantly improved in group A ( P <0.001) and C patients ( P <0.001) but remained unchanged in group B patients ( P =0.15). Varus deformity improved significantly in all patient groups. Immobilization time was significantly shorter in group A compared with group B and C patients ( P <0.001). However, numerical differences, although statistically significant, were not clinically relevant for all variables but immobilization time. Conclusions: This study showed good functional and radiologic outcomes in the pediatric population who had sustained closed, traumatic, displaced fracture of tibial diaphysis without associated fibula fracture. On the basis of the findings reported here, it is not contraindicated to operate skeletally immature patients with displaced fracture of tibial diaphysis without associated fibula fracture. However, results were essentially the same and either method is a satisfactory choice for pediatric tibia shaft fractures with an intact fibula. In particular, we found that conservative treatment was as efficacious as surgical treatment apart from the length of time for immobilization. Level of Evidence: Level III.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
