Biomedical subjects

D Birolini

Publications and source records attributed to D Birolini.

118 records · Page 7Linked to original sources

PubMedDate not supplied

[Traumatic right diaphragmatic hernia: report of a case and review of the diagnostic methods].

Rupture of the right hemidiaphragm from blunt trauma is uncommon. Better management and more rapid transportation of victims has increased the frequency with which patients sustaining this injury are arriving at the emergency room alive. A case of right-sided diaphragmatic hernia from blunt trauma in a 36-year-old man is reported. Diagnosis was established by chest x-ray, CT scan and digital exploration after unsuccessful thoracoscopy. The methods used for diagnosis of this condition are analysed.

Adult↗

PubMedDate not supplied

[Traumatic rupture of the diaphragm: study of 35 cases].

A retrospective review of 35 patients with diaphragmatic injury attended at the Emergency Service of the Hospital das Clínicas, University São Paulo is analysed. Diagnosis was made through chest roentgenogram (48.5%), peritoneal lavage (37%) and contrast studies (14.5%). The most common extra-abdominal lesion were due to head, pelvic and thoracic trauma. Thirty-one patients sustained injuries to the left-side and four to the right. Associated intra-abdominal injury occurred in 89% of them. Retroperitoneal haematoma, spleen and liver injury were the most frequent lesions. All cases were treated by laparotomy, pleural space irrigation through the diaphragmatic lesion, thoracic drainage and suture of the injury. The morbidity rate was 40% and deaths occurred in 22.8%. Based upon these data, we concluded: the mechanism of trauma, chest RX findings and pelvic fracture are important clues for early recognition; irrigation of pleural space seems to be important in order to prevent empyema. Despite of this, the mortality remains high.

Accidents, Traffic↗

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[Gastric epithelioid leiomyosarcoma simulating pancreatic pseudocyst. Report of a case and review of the literature].

The authors report a case of malignant gastric leiomyoblastoma (epithelioid leiomyosarcoma) which was mistaken for a pseudocyst of the pancreas. The patient was operated several times in another hospital. At one of the operations a cystogastrostomy was performed. In november, 1989, when operated again by us, a large tumoral mass arising from the posterior gastric wall was found. The histopathological diagnosis was leiomyoblastoma of the stomach. It is concluded that the wall of a pancreatic cystic lesion should always be submitted to histologic examination in order to be excluded the possibility of a malignant neoplasm.

Biopsy↗

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[Gastric wounds: study of 85 patients].

During January 1987 and December 1990 we studied 85 patients (75 males), the age varying between 6 and 47 years (mean 27.6) sustaining penetrating (81 patients) and blunt (4 patients) gastric wounds. The mortality rate was 17.6% (15 patients) with four deaths occurring during the surgical procedure as consequence of critical associated injuries. Only one death happened as consequence of gastric wound; 6 patients died during the first 24 hours of hospitalization because of irreversible shock, 9 deaths came about after the first day of hospitalization (4 sepsis, 3 respiratory failure, 2 head trauma). The morbidity rate among the 81 patients that survived after surgical treatment was 39.5% (32 patients). The main postoperative gastric complication was vomiting in 10 patients (5 presenting vagus nerve injury and 5 sustaining pancreatic and/or another hollow viscus wounds) one patient presented with gastric suture dehiscence. Among the 12 patients sustaining vagus nerve injury the presence of gastric complication was higher in the group that was not submitted to pyloroplasty (6 patients). Analysing the patients presenting gastric and pancreatic injuries we verified that morbidity rate was statistically significantly higher in this group (69.2%) than in overall morbidity (39.5%).

Abdominal Injuries↗

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[Simultaneous injury of 4 iliac veins by firearm: report of a case and review of the literature].

Iliac vessel injuries constitute approximately 10 percent of all vascular traumatic lesions. The high mortality rate is due to the massive exsanguination and the high frequency of associated injuries. Iliac vein injury occurs either isolated or in association with the arterial lesion. Multiple injuries of iliac veins are uncommon and frequently fatal. An unusual case, in which there were injuries of the four iliac veins by gunshot is described. A review of literature of this condition and a discussion about the diagnosis, treatment and factors affecting mortality rate is presented. No other such case has been found reported.

Adolescent↗

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[The price of progress].

Explore the source record for details and available documents.

Diffusion of Innovation↗

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[Metabolic response and aggression: potassium and water content of skeletal muscles].

The authors present the results of a study of the amount of water and potassium in small samples of skeletal muscle and of the intestinal wall of albino rats. Five groups of 10 animals were separated according to the following conditions: peritonitis, pyloric obstruction, intestinal obstruction, mesenteric ischemia and a control group. The results suggest that skeletal muscle is capable of buffering the increased amount of potassium liberated by the tissues which undergo acute trauma, until a critical concentration is reached. Further studies are needed to clarify some of the conflicting results obtained.

Animals↗

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Grynfelt hernia.

Lumbar hernias are very uncommon conditions. Less than 300 cases have been reported in the literature. They result from defects in the posterolateral abdominal wall. The authors report their experience with four lumbar hernias managed at the "Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo" from 1973 to 1993. Age ranged from 54 to 63 years. Three were female, two had right hernias and two had left ones. All patients were treated surgically. Three were repaired by simple suture. The main complications were early recurrence (one case) and infections (one case). In one, a prosthetic mesh (polypropylene) was used to repair the defect, and the recovery was uneventful. Surgical treatment is always indicated in Grynfelt hernia. Approximation of the muscles by primary nonabsorbable suture, grafts or prosthesis are very adequate therapeutic options for lumbar hernias.

Female↗

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[Abdominal surgical emergencies in patients with acquired immunodeficiency syndrome].

UNLABELLED: Patients with Acquired Immunodeficiency Syndrome (AIDS) may present acute abdomen with modified clinical manifestations which may lead to errors and delays in preoperative diagnosis, with frequent delays in treatment. PURPOSE: To study clinical signs, diagnostic criteria, etiology, surgical management and mortality in patients with AIDS submitted to exploratory laparotomy. METHODS: We reviewed the records of thirty-one AIDS patients admitted in the period 1986-1993 at the Emergency Surgical Service--Hospital das Clínicas, University of São Paulo submitted to exploratory celiotomy due to acute abdome. RESULTS: Abdominal pain was the most frequent symptom and the diagnosis of acute abdome was made based upon physical examination, laboratory tests and imaging techniques. Gastrointestinal tract perforation was the most frequent cause of acute abdome, mainly due to Cytomegalovírus infection. All patients presented postoperative complication, specially wound infection. Mortality rate was 42% due to sepsis and multiple organ failure. CONCLUSION: Based upon these data we conclude that: AIDS patients usually present masked clinical signs of acute abdomen; stomas should be formally indicated. Mortality is extremely high due to immunocompromised state, delayed diagnosis and treatment and non therapeutic celiotomies.

AIDS-Related Opportunistic Infections↗

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[Traumatic rupture of duodenal diverticulum. Report of a case and literature review].

Duodenal diverticulum is a common anatomic abnormality. Its inflammatory perforation is a rare complication, with less than 100 cases reported in the available literature. Traumatic perforation is exceedingly rare (only 3 cases reported). In this report one more case of traumatic perforation is presented, and the literature is reviewed focusing on the pathogenic, diagnostic and therapeutic aspects of this severe disease.

Abdominal Injuries↗