Navegando por Palavras-chave "Procedimentos cirúrgicos minimamente invasivos"
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- ItemSomente MetadadadosAvaliação da cicatrização ureteral após endopielotomia eletrocirúrgica em modelo porcino(Universidade Federal de São Paulo (UNIFESP), 2003) Andreoni, Cássio [UNIFESP]; Srougi, Miguel [UNIFESP]Introdução: A endopielotomia (EP), tratamento endoscopico para obstrucao da juncao ureteropielica, apresenta taxas de sucesso inferiores as da pieloplastia desmembrada. Essa diferenca talvez esteja relacionada a diferencas no processo de reconstituicao tecidual apos os dois procedimentos. Para entender melhor a regeneracao ureteral apos EP, foi conduzido um estudo histopatologico, imano-histoquimico e molecular do ureter do porco, apos endopielotomia com Acucise. METODO: Foram realizados EP bilaterais com Acucise em 28 porcos. Cateteres ureterais 7 French foram inseridos bilateralmente; os rins, ureteres e bexiga foram removidos para estudo apos zero, uma, duas, tres, seis, doze e dezoito horas; um, tres e cinco dias; uma, duas, quatro e oito semanas do procedimento. Os cateteres foram removidos apos quatro semanas. A area do, ureter em cicatrizacao e seguimentos de ureter controle foram estudados com microscopia otica; outra porcao dos mesmos segmentos foram congelados e RTPCR foram realizados para medir niveis de expressao de EGF, TGFa, TGFb1, TGFb2,, TGFb3, FGF, VEGF, IGF, PDGF, colageno tipo 1, integrina e fibronectina. Ademais, estudo imano-histoquimico para antiactina, antidesmina, e antimiosina foi realizado nos segmentos ureterais manipulados. RESULTADOS: Cicatrizacao completa da mucosa foi observada a partir de 2, semanas e completa-se em quatro semanas. Em nenhum caso a camada muscular, estava cobrindo toda a circunferencia ureteral. No ureter operado foi encontrada expressao elevada de KGF, VEGF, TGF-a, TGF-b1, apos duas horas do, procedimento e que se mantiveram altos por sete a catroze dias. O estudo de imuno-histoquimica revelou que os miocitos presentes no defeito ureteral eram, na realidade, miofibroblastos
- ItemAcesso aberto (Open Access)Punção com agulha de Veress no hipocôndrio esquerdo para a criação do pneumoperitônio: valor diagnóstico das provas de posicionamento da agulha em pacientes não selecionados(Colégio Brasileiro de Cirurgiões, 2011-02-01) Becker Junior, Otávio Monteiro; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Hypólito, Octávio Henrique Mendes; Miyahira, Susana Abe [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Machado, Afonso Cesar Cabral Guedes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Espirito Santo Departamento de CirurgiaObjective: To assess the effectiveness of the Veress needle puncture in the left hypochondrium and the accuracy of the tests described for the intraperitoneal correct positioning of the tip of the Veress needle in an unselected population. Methods: Ninetyone patients consecutively scheduled for Videolaparoscopy had the abdominal wall punctured in the left hypochondrium. There were no exclusion criteria. The patients received general anesthesia and mechanical ventilation according to the protocol. After puncturing five tests were used to confirm the positioning of the needle tip within the peritoneal cavity: aspiration test - AT; resistance to infusion - Pres; recovery of the infused fluid - Prec, dripping test - DT, and test of initial intraperitoneal pressure - IIPP. The test results were compared with results from literature for groups with defined exclusion criteria. The results were used for calculating sensitivity (S) specificity (E), positive predictive value (PPV) and negative predictive value (NPV). Inferential statistical methods were used to analyze the findings. Results: There were 13 failures. AT had E = 100% and NPV 100%. Pres had S = 100%, E = 0; PPV = 85.71%; NPV does not apply. Prec: S = 100%, E = 53.84%, PPV = 92.85%, NPV = 100%. DT: S = 100%, E = 61.53%, PPV = 93.97% NPV 100%. In IIPP, S, E, PPV and NPV were 100%. Conclusion: The puncture in the left hypochondrium is effective and the performed tests guide the surgeon regardless of sex, BMI, or previous laparotomy.
- ItemAcesso aberto (Open Access)Revascularização do miocárdio sem circulação extracorpórea: resultados da experiência de 18 anos de sua utilização(Sociedade Brasileira de Cirurgia Cardiovascular, 2001-03-01) Aguiar, Luciano de Figueiredo [UNIFESP]; Andrade, José Carlos Silva de [UNIFESP]; Branco, João Nelson Rodrigues [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Teles, Carlos Alberto [UNIFESP]; Gerola, Luís Roberto [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Myocardial revascularization without cardiopulmonary bypass is today an increasing alternative of revascularization although the limits of applicability are still to be defined. The authors review a series of cases and discuss its indications based upon their results. Patients and Methods: There were analyzed 2495 patients who underwent direct myocardial revascularization without extracorporeal circulation in the period from October 1981 to September 1999, from a total of 10656 patients, submitted to coronary bypass surgery during this period (23.4%). The age varied from 32 to 90 years (medium = 59) with most males (67%). Chronic coronary insufficiency was the most common surgical indication (70.8%) and the majority of the patients received 2 grafts (51.5%). Results: The global mortality rate (30 days) was 1.9% (48/ 2495) and only 45% of these patients needed blood transfusion. The global applicability of this technique was around 23%, however in the last 3 years the applicability was 32.8%, 35.1% and 42.2%. Conclusions: Myocardial revascularization without extracorporeal circulation is a safe tactical alternative for coronary insufficiency and has increased in the last years. This treatment is indicated in this subgroup of lower mortality and small incidence of postoperative complications. In the next years the use of this technique will increase with the use of stabilizers, special manipulation and functional revascularization.
- ItemAcesso aberto (Open Access)Sling de aponeurose e com faixa sintética sem tensão para o tratamento cirúrgico da incontinência urinária de esforço feminina(Federação Brasileira das Sociedades de Ginecologia e Obstetrícia, 2008-03-01) Sartori, João Paulo [UNIFESP]; Martins, José Antônio Moraes [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: to compare sling operations of aponeurosis and tension-free vaginal tape (TVT) for the correction of stress urinary incontinence (SUI) regarding: the rates of subjective and objective healing, the mobility of the bladder neck with ultrasonography, the variation of the absorbent test, the urodynamic alterations and the incidence of complications. METHODS: eighty patients with SUI were selected. Among them, 61 underwent a TVT surgery and 19, an abdominal rectum sling operation of aponeurosis. Average age, index of body mass and parity were 50.1 years old, 29.7 kg/m² and 4.1 deliveries (median=3) for the patients with aponeurosis sling, and 51.7 years old, 28.1 kg/m² and 4.1 deliveries (median=3) for the ones with TVT. All of them have undergone anamnesis, physical examination, bladder neck ultrasonography, absorbent test and urodynamic evaluation before and at least six months after the surgery. After 15 or 19 months and after about four or five years, they were again interviewed concerning the surgery results. RESULTS: after six months, 96.7% of the women with TVT and 89.5% of the ones with sling thought they were healed in the subjective evaluation. Nevertheless, after 15 to 19 months, the TVT Group kept the same subjective healing rate, while among the Sling Group the rate decreased to 77.8%. There was a significant decrease in the mobility of the neck bladder that was similar in both groups and an improvement in the absorbent test. At the end of the urodynamic study, 93.4% of the women from the TVT Group and 78.9% of the ones from the Sling Group were classified as having an objective healing. The average time of bladder probing was higher in the Sling Group. Urinary retention was observed in 42.1% of the sling cases and in 9.8% of the TVT's. The rates of late healing were 90% for TVT and 55.6% for sling. CONCLUSIONS: TVT surgery provided better subjective healing after 15 or 19 months, but the rate of objective healing was the same in both techniques at that time. Among the complications detected, the urinary retention was higher in the Sling Group, in the post-surgery period.
- ItemAcesso aberto (Open Access)Sling retropúbico e transobturatório no tratamento da incontinênca urinária de esforço(Associação Médica Brasileira, 2010-01-01) Tanuri, Andrea Lopes Salzedas [UNIFESP]; Feldner Junior, Paulo Cezar [UNIFESP]; Bella, Zsuzsanna I.k. Jarmy-di [UNIFESP]; Castro, Rodrigo de Aquino [UNIFESP]; Sartori, Marair Gracio Ferreira [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aim of this study was to compare results of retropubic and transobturator sling for surgical treatment of female stress urinary incontinence (SUI). METHODS: Thirty randomized patients with SUI were divided in two groups, twenty who underwent the transobturator sling and ten the retropubic sling procedure. .Patients were assessed before and after one, six and twelve months of treatment by clinical history, physical examination, quality of life questionnaire (King's Health Questionnaire), pad test and urodynamic parameters. At preoperative both groups were homogenous. RESULTS: One year after surgery, incontinence and quality of life questionnaire parameters had improved significantly in both groups and there was no difference between them. There was significant reduction in the pad test in both groups. Concerning urodynamic evaluation, one year after surgery cure rates were 84.2% for the transobturator group and 88.8% for the retropubic,. Subjective cure rate was 85% in the transobturator group and 88.8% in the retropubic. No statistical difference was found in complications rates. CONCLUSION: Retropubic and transobturator slings were effective in treatment of female SUI at one-year follow-up. Both techniques had significant cure rates and improved the quality of life with few complications.
- ItemAcesso aberto (Open Access)Vitrectomia transconjuntival: dados preliminares com o sistema Millennium TSV-25(Conselho Brasileiro de Oftalmologia, 2005-12-01) Rezende Filho, Flávio [UNIFESP]; Alcântara, Simone; Régis, Luiz Gustavo Tonelli; Universidade Federal de São Paulo (UNIFESP); Pontifícia Universidade Católica do Rio de Janeiro; Centro de Estudos e Pesquisas Oculistas AssociadosPURPOSE: To report the preliminary surgical results of pars plana vitrectomy with a transconjunctival technique using the TSV-25 Millennium system. METHODS: Twenty consecutive patients (20 eyes) that underwent transconjunctival vitrectomy with the TSV-25 Millennium system, between July 2003 and January 2004, were prospectively postoperatively followed for a minimum period of one month. Eyes with macular hole, epiretinal membrane, macular edema, rhegmatogenous retinal detachment, endophthalmitis, and vitreous hemorrhage with or without tractional retinal detachment were included. Intra and post-operative complications and difficulties were recorded. RESULTS: All 20 patients completed at least one month postoperative follow-up. There were 4 macular holes, 2 epiretinal membranes, 2 cystoid macular edemas post-cataract surgery, 1 diabetic macular edema, 5 rhegmatogenous retinal detachments, 5 vitreous hemorrhages (2 associated with tractional retinal detachment), and 1 endophthalmitis. Mean postoperative day one intraocular pressure was 15.7 mmHg (6 - 46 mmHg) and at one postoperative month it was 14.2 mmHg (8 - 22 mmHg). There were no cases of sclerotomy-related retinal breaks, postoperative endophthalmitis, or ocular hypotony. Three of 5 eyes (60%) with retinal detachment needed further surgical intervention (all pseudophakic) and 4 of 5 eyes (80%) with vitreous hemorrhage had postoperative residual hemorrhage. All cases with macular diseases and phakic retinal detachments were successful with one surgery. CONCLUSION: This transconjunctival vitrectomy technique showed as its main benefits the low incidence of sclerotomy-related breaks and postoperative ocular hypertension. An adequate case selection seems to be crucial.