Percorrer por autor "Marino, Flávio"
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- Passing Through a Hole: Delayed Diaphragmatic Hernia After Cytoreductive SurgeryPublication . Mestre, Ana; Ferreira Simões, André; Marino, Flávio; Gonçalves Pereira, JoãoA diaphragmatic hernia is a protrusion of abdominal contents into the thoracic cavity. Although it is commonly congenital, diaphragmatic hernias can also be acquired. Blunt or penetrating trauma are among the most frequent causes, although spontaneous or iatrogenic cases have been reported. Recently, some case reports related to diaphragmatic hernia after debulking surgery for advanced ovarian cancer have been described. This is an exceedingly rare but life-threatening complication, being prompt recognition and surgical correction critical. We report a case of a delayed diaphragmatic hernia in a 19-year-old female resulting from cytoreductive surgery for advanced ovarian cancer. Rapid evolution from gastrointestinal symptoms to hypovolemic shock occurred, and intensive care admission was required. Immediate surgery was critical to improving the patient outcome. This case highlights this uncommon but life-threatening complication, the challenges of diagnosing and managing those patients, and the need for early recognition, support, and surgical correction.
- Pneumocephalus Following an Accidental Dural Puncture, Treated Using Hyperbaric Oxygen Therapy. A Case ReportPublication . Marino, Flávio; Simões, André Ferreira; Simas, Ângela; Pereira, João GonçalvesIntroduction: Neuraxial techniques, including epidural anaesthesia, are often used for perioperative pain control and are generally safe. However, both transient, mild and even severe, life-threatening neurologic complications can occur. Case presentation: A seventy-eight-year-old man was admitted to the hospital for a radical nephrectomy plus transurethral resection due to kidney and bladder cancer. During the epidural exploration, an accidental dural puncture was noted. This was followed by the patient complaining of an intense headache. The epidural catheter was placed in a different location, and surgery was performed uneventfully. The patient presented with confusion, agita-tion, vertical nystagmus, vision loss, and paraparesis about two hours later. The epidural levobupivacaine and mor-phine infusion were stopped, followed by motor block resolution. A computerized head-tomography scan showed extra-axial multiple air spots involving the frontal and temporal lobes. Emergent hyperbaric oxygen therapy was commenced. After a single session, there was complete resolution of all symptoms and a marked reduction in the number and volume of the extra-axial air visible on the CT scan. Conclusions: Although rare, pneumocephalus is a well-recognized complication of a dural puncture. Its rapid recognition in a patient with new-onset neurological symptoms and early treatment with hyperbaric oxygen therapy allows rapid clinical and imaging resolution and an improved prognosis.