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Gastrointestinal perforations usually lead to pneumoperitoneum and peritonitis. Rarely, if ever described, a complete giant staghorn renal stone might cause a nephrocolic fistula with sigmoid impaction and perforation similar to gallstone ileus. Few nephrointestinal fistulae have been described in the literature and none of them were presented as an acute abdomen with pneumoperitoneum and pneumoretroperitoneum. To our knowledge, this is the only case showing CT and radiographic findings of a pathology not yet described in the literature. We named the sigmoid perforation by a renal stone ileus "Lorenzi's syndrome" after the physician who hypothesized this rare differential diagnosis based only on history and clinical examination.

Background and objectives: Hyperglycemia in surgical patients may cause serious problems. Analyzing this complication in this scenario contributes to improve the management of these patients. The aim of this study was to evaluate the prevalence of hyperglycemia in the postanesthetic care unit (PACU) in non-diabetic patients undergoing elective surgery and analyze the possible risk factors associated with this complication. Methods: We evaluated non-diabetic patients undergoing elective surgeries and admitted in the PACU. Data were collected from medical records through precoded questionnaire. Hyperglycemia was considered when blood glucose was >120 mg.dL −1 . Patients with hyperglycemia were compared to normoglycemic ones to assess factors associated with the problem. We excluded patients with endocrine-metabolic disorders, diabetes, children under 18 years, body mass index (BMI) below 18 or above 35, pregnancy, postpartum or breastfeeding, history of drug use, and emergency surgeries. Results: We evaluated 837 patients. The mean age was 47.8 ± 16.1 years. The prevalence of hyperglycemia in the postoperative period was 26.4%. In multivariate analysis, age (OR = 1.031, 95% CI 1.017---1.045); BMI (OR = 1.052, 95% CI 1.005---1.101); duration of surgery (OR = 1.011, 95% CI 1.008---1.014), history of hypertension (OR = 1.620, 95% CI 1.053---2.493), and intraoperative use of corticosteroids (OR = 5.465, 95% CI 3.421---8.731) were independent risk factors for postoperative hyperglycemia. Conclusion: The prevalence of hyperglycemia was high in the PACU, and factors such as age, BMI, corticosteroids, blood pressure, and duration of surgery are strongly related to this complication. PALAVRAS-CHAVECirurgia eletiva; Hiperglicemia; Prevalência; Fatores de risco; Sala de recuperação anestésica Avaliação de hiperglicemia na sala de recuperação pós-anestésicaResumo Justificativa e objetivos: Hiperglicemia em pacientes cirúrgicos pode ocasionar graves problemas. Nesse contexto, analisar essa complicação contribui para o melhor manejo desses pacientes. O objetivo do estudo foi avaliar a prevalência de hiperglicemia na sala de recuperação pós-anestésica (SRPA) em pacientes não diabéticos submetidos a cirurgias eletivas e analisar os possíveis fatores de risco associados a essa complicação. Métodos: Foram avaliados pacientes não diabéticos submetidos a cirurgias eletivas e admitidos na SRPA. Os dados foram coletados dos prontuários por meio de questionário pré-codificado. Foi considerada hiperglicemia quando a glicemia era > 120 mg.dL −1 . Pacientes com hiperglicemia foram comparados com os normoglicêmicos para avaliar fatores associados ao problema. Foram excluídos os pacientes com distúrbios endócrino-metabólicos, diabéticos, menores de 18 anos, índice de massa corpórea (IMC) menor do que 18 ou maior do que 35, gestação, puerpério ou aleitamento materno, antecedente de uso de drogas e cirurgias de urgência. Resultados: Foram avaliados 837 pacientes. A média de idade foi 47,8 ± 16,1 anos. A prevalên-cia de hiperglicemia n...

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Objectives: To describe the feasibility and perinatal outcomes of fetal microneurosurgery for intrauterine myelomeningocele repair assisted by a high-definition exoscope system. Methods: A prospective cohort of consecutive fetuses with isolated open spina bifida referred to our fetal surgery centre in Querétaro, Mexico, during a three-year period (2016-2019). Fetal intrauterine myelomeningocele (MMC) repair was performed through a 1.5cm hysterotomy with the assistance of a high-definition three-dimensional exoscope system. Results: A cohort of 47 consecutive cases underwent fetal microneurosurgery for intrauterine MMC repair. A complete three-layer correction was feasible in all cases at a median gestational age (GA) of 25.3 (22.9-27.6) weeks and a median surgical time of 110 (64-200) min. Preterm rupture of the membranes was observed in eight cases (19.0%) at a median GA of 31.4 (26.0-35.1) weeks. The median GA at delivery was 35.1 (range, 26.0-39.6) weeks. During infant follow-up, 8 cases (19.0%) developed hydrocephaly requiring ventriculoperitoneal shunt placement or neuroendoscopy. All patients showed intact hysterotomy site at delivery. There were no maternal or fetal deaths but two neonatal deaths (4.8%) were reported due to complications related to preterm delivery. Conclusions: Intrauterine MMC repair by exoscopic-assisted microneurosurgery is feasible and is associated with good perinatal outcomes.