Search

BACKGROUND: Portal vein embolization is an accepted procedure that provides hypertrophy of the future remnant liver in order to reduce post-hepatectomy complications. AIM: To present a series submitted to portal vein embolization using an adapted hysterosalpingography catheter via transileocolic route. METHODS: Were performed right portal branch embolization in 19 patients using hysterosalpingography catheter. For embolizing the vessel, was used Gelfoam(r) powder with absolute alcohol solution. Indications for hepatectomy were colorectal liver metastases in all cases. RESULTS: An adequate growth of the future remnant liver was achieved in 15 patients (78.9%) and second time hepatectomy could be done in 14 (73.7%). In one patient (5.2%), tumor progression prevented surgery. One patient presented acute renal failure after portal embolization. CONCLUSIONS: The hysterosalpingography catheter is easy to handle and can be introduced into the portal vein with a wire guide. There were no major post-embolization complication. Its use is safe, cheap and effective. RACIONAL: Embolização da veia porta é procedimento consagrado para estimular a hipertrofia do fígado remanescente, a fim de reduzir as complicações pós-hepatectomia. OBJETIVO: Apresentar série de casos submetidos à embolização da veia porta usando cateter adaptado de histerossalpingografia, por via transileocólica. MÉTODOS: Foi realizada embolização do ramo portal direito em 19 pacientes utilizando cateter de histerossalpingografia. Foi usado Gelfoam(r) em pó com solução de álcool absoluto, como material embolizante. As indicações para hepatectomia foram metástases hepáticas colorretais em todos os casos. RESULTADOS: Hipertrofia adequada do fígado remanescente foi alcançada em 15 pacientes (78,9%) e a hepatectomia foi realizada em 14 (73,7 %). Em um (5,2 %), a progressão do tumor impediu a realização da operação. Um paciente apresentou insuficiência renal aguda após embolização portal. CONCLUSÕES: O cateter de histerossalpingografia é fácil de ser manuseado e pode ser introduzido na veia porta com um fio guia. Não houve complicação grave pós-embolização. Seu uso é seguro, barato e eficaz.

Background. An adequate blood flow is directly related to graft survival in living donor liver transplantation. However, in some cases, unfavorable conditions prevent the use of the hepatic artery for arterial reconstruction. Herein, we report a case in which the recipient right gastroepiploic artery was used as an option for arterial reconstruction in adult-to-adult living donor liver transplantation. Case Report. A 62-year-old woman, with cirrhosis due to hepatitis B associated with hepatocellular carcinoma, was submitted to living donor liver transplantation. During surgery, thrombosis of the hepatic artery with intimal dissection until the celiac trunk was observed, which precluded its use in arterial reconstruction. We decided to use the right gastroepiploic artery for arterial revascularization of the liver graft. Despite the discrepancy in size between donor hepatic artery and recipient right gastroepiploic artery, anastomosis was performed successfully. Conclusions. The use of the right gastroepiploic artery as an alternative for arterial revascularization of the liver graft in living donor liver transplantation should always be considered when the hepatic artery of the recipient cannot be used. For performing this type of procedure, familiarity with microsurgical techniques by the surgical team is necessary.

Anatomical resection of segment VIII (SVIII) is one of the most difficult hepatectomies to perform. Although it is the best choice of surgical treatment for tumors located at SVIII, its feasibility can be compromised when the right hepatic vein (RHV) must be resected en bloc with SVIII. Herein we describe a case of a cirrhotic patient that was submitted to segmentectomy VIII in bloc with the main trunk of the RHV, due to hepatocellular carcinoma. The resection could only be performed because a well developed inferior right hepatic vein (IRHV) was present. Anatomical variations of the liver vascularization should be used by liver surgeons to improve surgical results.

Inflammatory pseudotumor of the liver (IPTL) is a rare condition, but an important differential diagnosis of hepatic space-occupying lesions. It may regress spontaneously and mimic other liver tumors. Complications are usually intrahepatic. Herein, we present a case of IPTL which developed pleural empyema and lung necrosis as an uncommon complication.

Caroli's disease (CD) is a rare autosomal recessive disorder characterized by intrahepatic cystic dilatation of the bile ducts. Patients with bilobar or progressive disease may require orthotopic liver transplantation (OLT). In the MELD era, living donor liver transplantation (LDLT) raised as the ultimate treatment option for these patients, once their MELD score is usually low. Herein, we describe 2 cases of patients (a 2-year-old girl and a 19-year-old teenager) that successfully underwent LDLT as a treatment for diffuse CD. The good postoperative courses of the two cases indicate that LDLT is a feasible option in the treatment of this disorder, even in complicated or early age patients.

The knee is an anatomically and biomechanically complex joint. Few studies have been published reporting the type and frequency of knee injuries. However, this information that may help to prevent, diagnose, and treat knee joint injuries. We have documented 17,397 patients with 19,530 sport injuries over a 10-year period of time. 6434 patients (37%) had 7769 injuries (39.8%) related to the knee joint. 68.1% of those patients were men and 31.6% were women. Almost 50% of the patients were between the ages of 20-29 (43.1%) at the time of injury. The injuries documented were ACL lesion (20.3%), medial meniscus lesion (10.8%), lateral meniscus lesion (3.7%), MCL lesion (7.9%), LCL lesion (1.1%), and PCL lesion (0.65%). The activities leading to most injuries were soccer (35%) and skiing (26%). LCL injury was associated with tennis and gymnastics, MCL with judo and skiing, ACL with handball and volleyball, PCL with handball, lateral meniscus with gymnastics and dancing, and medial meniscus with tennis and jogging.

In dieser Arbeit wird ein Konzept für das betriebliche Gesundheitsmanagement an einem Fachkrankenhaus für Neurologie und Psychiatrie erstellt. Hierbei werden zunächst allgemeine Grundlagen sowie die Entwicklung und Teilbereiche des betrieblichen Gesundheitsmanagements dargestellt. Darauf basierend wird anschließend am praktischen Beispiel eines Fachkrankenhauses für Neurologie und Psychiatrie mit Hilfe einer Mitarbeiterbefragung sowie einer Literaturrecherche ein organisatorisches und inhaltliches Konzept für das betriebliche Gesundheitsmanagement entworfen. Inhaltlich umfasst dieses die alters- und berufsgruppenspezifisch bedarfsorientierte Entwicklung von Maßnahmen und Angeboten an zwei Gesundheitstagen jährlich, sowie die dauerhafte Etablierung verschiedener Angebote zur Förderung der Gesundheit und Prävention von Erkrankungen der Mitarbeiter. Weiterhin werden die notwendigen organisatorischen Determinanten erarbeitet, die zur Einführung, Weiterentwicklung und Überprüfung der Wirksamkeit des BGM erforderlich sind. Im abschließenden Fazit erfolgen eine aktuelle Bewertung der Konzeption und ein Ausblick in die Zukunft.

Einleitung: Arbeitsbedingte Erkrankungen des Muskel-Skelett-Systems sind unter Physiotherapeuten sehr häufig. Die präventive Forschung hat diese Berufsgruppe bisher kaum untersucht. In diesem Zusammenhang stellt die Veränderung des Arbeitsumfeldes einen vielversprechenden Ansatz für die Verhinderung arbeitsbedingter Erkrankungen dar. Das Ziel dieser Arbeit ist die Erstellung einer Checkliste zur Bewertung des Arbeitsplatzes eines Physiotherapeuten zu erstellen. Material und Methoden: Es wurde im September 2011 eine Literatursuche mit folgenden Datenbanken und Suchmaschinen durchgeführt: „CEBP“, „Cochrane“, „Ebsco“, „GoogleScholar“, „Medpilot“, „PeDro“, „Pubmed“ und dem Online-Katalog der württembergischen Landesbibliothek. Nach systematischem Aussortieren verblieben 13 Studien und zwei Bücher, zu denen durch unsystematische Suche weitere zwei Bücher hinzukamen. Aus den Suchergebnissen wurden Daten erhoben, die für die Erstellung einer Checkliste relevant sind. Ergebnisse: Es entstand eine literaturgestützte Checkliste, die sowohl direkt angewendet, als auch als Hilfe zur Entwicklung einer individuellen Arbeitsplatzumgestaltung verwendet werden kann. Diskussion: Eine literaturgestützte Checkliste zur Beurteilung des Arbeitsplatzes eines Physiotherapeuten ist, nach Wissensstand des Autors, in dieser Form einzigartig. Jeder einzelne Punkt der Checkliste wird näher und von verschiedenen Blickwinkeln beleuchtet. Introduction: Work related musculoskeletal disorders are common among physiotherapists. Preventive research examined this profession rarely until today. In this background changing working environment could be an important way to prevent work related illnesses. The aim of this study is the creation of a checklist for assessing the workplace of a physiotherapist. Material and Methods: A search for literature took place in September 2011 in following databases and search engines: “CEBP“, “Cochrane“, “Ebsco“, “GoogleScholar“, “Medpilot“, “PeDro“, “Pubmed“ and the online-catalogue of the “württembergische Landesbibliothek”. After a systematic sort out remained 13 studies and two books to which another two books from an unsystematic search were added. From the results of the searches relevant data to create a checklist were extracted. Results: A literature-based checklist was developed, which can be used directly or as a help to develop an individual workplace change program. Discussion: In the knowledge of the author a literature-based checklist for assessing the workplace of a physiotherapist is unique. Each checklist item is described more closely and discussed separately.