Navegando por Palavras-chave "Abdomen"

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    Aumento mamário por meio da incisão da abdominoplastia: estudo prospectivo de 100 casos
    (Sociedade Brasileira de Cirurgia Plástica, 2013-03-01) Dini, Gal Moreira [UNIFESP]; Milani, Jean [UNIFESP]; Albuquerque, Luciana Gianini; Oliveira, Mario Farinazzo de [UNIFESP]; Santos Filho, Ivan Dunshee de Abranches Oliveira [UNIFESP]; Iurk, Lauren Klas [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Cidade de São Paulo
    INTRODUCTION: Pregnancy and obesity cause distension of the abdominal wall and produce changes in the shape and size of the breasts. Thus, the need of aesthetic improvement of the abdominal area is not uncommon, coinciding with the desire for breast augmentation. Performing mammoplasty via the abdominoplasty incision approach was first described in 1976. Because of the lack of prospective studies using this approach, we performed a series of dermolipectomy procedures using the abdominal incision to insert a pair of silicone gel breast implants. METHODS: In total, 100 consecutive patients were selected, with a mean age of 33 ± 2 years. Classic abdominoplasty was performed, and 2 tunnels were then made in the right and left hypochondria. After implant placement, the mammary fold was reconstructed using simple sutures with absorbable threads to attach the subcutaneous tissue to the aponeurosis. RESULTS: None of the following complications were observed: deep-vein thrombosis, cardiorespiratory or anesthetic complications, skin necrosis, visible bleeding, hematoma, or clinically detectable infection. The volume of the implants ranged from 280 to 450 mL (median, 350 mL). The mean operation time was 116 minutes. Reoperation was not necessary in any of the cases. The monitoring period ranged from 9 to 84 months (mean, 36 months). CONCLUSIONS: Breast augmentation via the abdominoplasty incision approach was demonstrated to be a reliable and simple technique, providing a new, scar-free alternative to mammary surgical procedures.
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    Effects of Abdominoplasty on Female Sexuality: A Pilot Study
    (Wiley-Blackwell, 2012-03-01) Azevedo de Brito, Maria Jose [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Bussolaro, Rodolpho Alberto [UNIFESP]; Shinmyo, Lia Mayumi [UNIFESP]; Barbosa, Marcus Vinicius [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction. Changes in the pubic region resulting from abdominoplasty may have a psychosexual impact. Thus, it is important to study the influence of physical changes on the sexuality of patients after abdominoplasty. Aim. To evaluate the effects of the elevation of the mons pubis and consequent exposure of the clitoris in the vulvar commissure on the sexual functioning and sexual satisfaction of women who underwent abdominoplasty. Methods. Data were presented as mean +/- standard deviation. Nineteen women with a mean age of 35 +/- 7 years, mean body mass index of 23 +/- 2 kg/m(2) and who expressed a desire to undergo abdominoplasty were selected from consecutive patients attending the abdominal plastic surgery outpatient unit of a university hospital. Main Outcome Measures. Physical change (measured by the distance between the xiphoid process and vulvar commissure [xipho-vc]), sexual functioning, and sexual satisfaction (assessed with the Sexuality Assessment Scale), and body image (measured using the Body Shape Questionnaire [BSQ]) were evaluated preoperatively and 6 months after abdominoplasty. Results. There was a significant reduction (P = 0.0004; z = -3.53) in the xipho-vc distance 6 months after abdominoplasty compared with baseline (mean difference 3.63 +/- 2.79 cm), corresponding to an elevation of the mons pubis and consequent exposure of the clitoris. All patients reported a significant improvement in sexual functioning and sexual satisfaction 6 months after abdominoplasty when compared with baseline (P = 0.0001; z = -3.83). BSQ scores indicated an improvement in the patients' concerns about body shape (P = 0.0003; z = -3.58). Conclusion. Our results suggest that physical change and the new position of the clitoris may have a positive impact on sexuality. de Brito MJA, Nahas FX, Bussolaro RA, Shinmyo LM, Barbosa MVJ, and Ferreira LM. Effects of abdominoplasty on female sexuality: A pilot study. J Sex Med 2012; 9: 918-926.
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    Estado atual do diagnóstico e tratamento da apendicite aguda na criança: avaliação de 300 casos
    (Colégio Brasileiro de Cirurgiões, 2005-12-01) Vital Junior, Pedro Felix [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: In our clinical practice, we have observed that despite the great technological advances in diagnostic methods acute appendicitis still represents a problem in children, resulting in late diagnosis and treatment, and case of greater severity. Our objective is to assess the current state of diagnosis and treatment of acute appendicitis in children treated in two important referral hospitals of São Paulo (Brazil), over a 30 month's period. METHODS: The variables studied were: age, sex, clinical manifestations, time for the diagnosis to be established, the findings from physical examination and laboratory tests, surgical findings and antibiotic protocols, postoperative complications and hospital lenght of stay. RESULTS: In the present sample, of 300 children, 65% were boys and 35% girls, with an initial diagnosis of appendicitis being made in 63% of the cases. The signs and symptoms most frequently encountered were: abdominal pain in the right iliac fossa (85.3%) and peritoneal irritation in this region (82%). We identified leukocytosis in 83% of the patients and the urine analysis showed leukocyturia in 39.7% of the patients. Around 92.4% of the simple radiological studies of the abdomen produced images that were not specific to acute appendicitis. Ultrasonography studies diagnosed the disease in 80.1% of the cases. Various antibiotic schemes were used, although there was special attention towards Gram-negative and anaerobic bacteria. The main complication was infection of the surgical wound, and there was no mortality. The average hospital length of stay was 5 days. CONCLUSION: In spite of greater knowledge of acute appendicitis and greater refinement of laboratory and radiological techniques, the diagnosis is still delayed and disease constitutes a cause of great morbidity among pediatric age groups.
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    Impaired Abdominal Skin Sensory Function in Morbid Obesity and After Bariatric Surgery
    (Springer, 2012-03-01) Bussolaro, Rodolpho Alberto [UNIFESP]; Garcia, Elvio Bueno [UNIFESP]; Zanella, Maria Teresa [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Bariatric surgery reduces body weight, but creates the need for surgical correction of the patient's body shape, especially of the abdomen. the abdominal skin of the ex-obese has a lower quantity of fibrous and non-fibrous components; however, its functional status has not yet been studied. This study quantified, at different depths, the neurological function of the abdominal skin of the obese and morbidly ex-obese.Semmes-Weinstein monofilaments were used to quantify sensory levels of abdominal skin at the supra-umbilical (SU), umbilical (U), and infra-umbilical (IU) levels in 25 currently morbidly obese, 56 post-bariatric patients (open Roux-en-Y gastric bypass), and 43 women with normal body weight and/or overweight without previous obesity (control).Only the control group showed a positive correlation between a worsening of sensory perception and age (p = 0.02). in the morbid obesity group, sensory threshold was higher at the IU level (9.60 g/mm(2)) than at the U (5.86 g/mm(2)) and SU (5.38 g/mm(2)) levels (p < 0.05). the mean sensory threshold for morbid obesity subjects (6.95 g/mm(2)) was higher than that of the post-bariatric patients (4.44 g/mm(2)), which in turn was higher than that of the control group (3.47 g/mm(2)), p < 0.01.Morbidly obese and post-bariatric patients have lost the normal positive correlation between age and skin sensitiveness. the IU region has sensitiveness compromised in morbid obesity. Sensory thresholds in post-bariatric patients showed improvement relative to morbidly obese, but remained worse than the control subjects.
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    Improving tension decrease in components separation technique
    (Springer, 2014-02-01) Barbosa, Marcus Vinicius [UNIFESP]; Ayaviri, N. A. M. [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Juliano, Y. [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Univ Franca; Universidade Federal de São Paulo (UNIFESP)
    The purpose of this study is to evaluate the tension at the aponeurotic edges after the undermining of the anterior rectus sheath associated with the classic components separation in cadavers.Twenty fresh adult cadavers were placed supine and an incision in the anterior rectus sheath was done, thus exposing the posterior sheath. the two levels to be studied were marked 3 cm above and 2 cm below the umbilicus. An analogical dynamometer was used to measure the traction values, consecutively during four stages as follows: initial stage, no aponeurotic undermining; Stage 1, separation of the anterior rectus sheaths; Stage 2, after Stage 1 the external oblique aponeurosis were incised along the semilunaris and the external oblique muscles were undermined; Stage 3, after Stage 2 rectus muscles were completely separated from their posterior sheaths. Statistical analysis was done by Friedman's analysis of variance (p < 0.05).There was a progressive and significant decrease in tension along the stages (Friedman's analysis of variance, p < 0.001). Traction indexes were higher in the initial stage and became gradually lower along the other stages.The undermining of the anterior rectus sheaths helps to decrease tension during the components separation technique.Level V, experimental study.
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    Is it Possible to Repair Diastasis Recti and Shorten the Aponeurosis at the Same Time?
    (Springer, 2014-04-01) Veríssimo, Pamella [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Barbosa, Marcus Vinicius [UNIFESP]; Carvalho Gomes, Heitor Francisco de [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Mandaqui Hosp Complex
    Abdominal wall deformity secondary to pregnancy is multidirectional. Plication of the anterior rectus sheath is the most widely used technique for correction of this condition. However, it would be desirable to simultaneously perform the transverse and longitudinal repair of this deformity. the aim of this study was to assess changes in the length of the musculoaponeurotic layer after diastasis recti repair using triangular mattress sutures.Thirty-one women with Nahas' type III/A deformity were divided into two groups: the triangular mattress suture (TS) group and the continuous suture (CS) group. All patients underwent conventional abdominoplasty and diastasis recti repair with medial longitudinal plication performed between two metal clips. the two types of suture were used in both groups. in the TS group, after a CS was performed and removed, TSs were used and maintained in place. in the CS group, the order of suture placement was reversed. the distance between clips was measured before and immediately after suturing and at 3 weeks and 6 months postoperatively using plain abdominal radiographs. Statistical analysis was conducted using Friedman's analysis of variance and Wilcoxon's test.The use of TSs significantly reduced the length of the aponeurosis compared with both the intraoperative situation without suture (P < 0.001) and the use of CS (intraoperatively and 6 months after surgery; P < 0.001).The repair of diastasis recti using TSs resulted in vertical shortening of musculoaponeurotic layer immediately after the procedure and in the long term.This journal requires that authors assign a level of evidence to each article. for a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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    Main controversies in the nonoperative management of blunt splenic injuries
    (Pagepress Publ, 2016) Marcante Carlotto, Jorge Roberto [UNIFESP]; Lopes-Filho, Gaspar de Jesus [UNIFESP]; Colleoni-Neto, Ramiro [UNIFESP]
    Introduction: The nonoperative management of traumatic spleen injuries is the modality of choice in patients with blunt abdominal trauma and hemodynamic stability. However, there are still questions about the treatment indication in some groups of patients, as well as its follow-up. Aim: Update knowledge about the spleen injury. Method: Was performed review of the literature on the nonoperative management of blunt injuries of the spleen in databases: Cochrane Library, Medline and SciELO. Were evaluated articles in eng and por, between 1955 and 2014, using the headings "splenic injury, nonoperative management and blunt abdominal trauma". Results: Were selected 35 articles. Most of them were recommendation grade B and C. Conclusion: The spleen traumatic injuries are frequent and its nonoperative management is a worldwide trend. The available literature does not explain all aspects on treatment. The authors developed a systematization of care based on the best available scientific evidence to better treat this condition.
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    New Trends in Diffusion-Weighted Magnetic Resonance Imaging as a Tool in Differentiation of Serous Cystadenoma and Mucinous Cystic Tumor: A Prospective Study
    (Karger, 2011-01-01) Schraibman, Vladimir [UNIFESP]; Goldman, Suzan Menasce [UNIFESP]; Ardengh, Jose Celso; Goldenberg, Alberto [UNIFESP]; Lobo, Edson [UNIFESP]; Linhares, Marcelo Moura [UNIFESP]; Gonzales, Adriano Mizziara [UNIFESP]; Abdala, Nitamar [UNIFESP]; Abud, Thiago Giansante [UNIFESP]; Ajzen, Sergio Aron [UNIFESP]; Jackowsky, Andrea; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Fundacao Inst Pesquisa & Estudo Diagnost Imagem
    Background/Aims: Pancreatic cystic lesions are increasingly being recognized. Magnetic resonance imaging (MRI) is the method that brings the greatest amount of information about the morphologic features of pancreatic cystic lesions. To establish if diffusion-weighted MRI (DW-MRI) can be used as a tool to differentiate mucinous from nonmucinous lesions. Methods: Fifty-six patients with pancreatic cystic lesions (benign, n = 46; malignant, n = 10) were prospectively evaluated with DW-MRI in order to differentiate mucinous from nonmucinous lesions. Final diagnosis was obtained by follow-up (n = 31), surgery (n = 16) or endoscopic ultrasound-guided fine needle aspiration (n = 9). Serous cystadenoma was identified in 32 (57%) patients. Results: the threshold value established for the differentiation of mucinous from nonmucinous lesions was 2,230.06 s/mm(2) for ADC of 700. DWI-MRI behavior between mucinous and nonmucinous groups revealed sensitivity, specificity, positive predictive value, negative predictive value and accuracy to be 80, 98, 92, 93 and 93%, respectively (p<0.01, power of sample = 1.0). in the comparison of the diffusion behavior between mucinous (n = 13) and serous (n = 32) lesions, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100, 97, 92, 100 and 98%, respectively (p<0.01, power of sample = 1.0). the results of endoscopic ultrasound-guided fine needle aspiration were similar to those of DW-MRI. Conclusions: DW-MRI can be included as part of the array of tools to differentiate mucinous from nonmucinous lesions and can help in the management of pancreatic cystic lesions. Copyright (C) 2011 S. Karger AG, Basel and IAP
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    Plicatura da lâmina anterior da bainha dos músculos retos do abdome com a técnica de sutura triangular
    (Universidade Federal de São Paulo (UNIFESP), 2013) Veríssimo, Pamella [UNIFESP]; Nahas, Fábio Xerfan; Gomes, Heitor Francisco de Carvalho [UNIFESP]; Barbosa, Marcus Vinícius Jardini [UNIFESP]; http://lattes.cnpq.br/2266460253828291; http://lattes.cnpq.br/3485738680161626; http://lattes.cnpq.br/3567288065904681; http://lattes.cnpq.br/2034024966821166; Universidade Federal de São Paulo (UNIFESP)
    A deformidade musculo-aponeurotica da parede abdominal decorrente da gestacao e multidirecional. A tecnica mais utilizada para sua correcao e a plicatura da aponeurose anterior. Seria desejavel obter ao mesmo tempo uma correcao transversal e longitudinal. O objetivo deste estudo e avaliar o eixo vertical do plano musculo-aponeurotico apos o uso da sutura triangular na correcao da diastase de retos. Metodos: Foram selecionadas 31 pacientes com deformidade abdominal tipo III/A de Nahas, divididas em dois grupos (GST- grupo sutura triangular e GSC u grupo sutura continua). Estas foram submetidas a abdominoplastia e correcao da diastase dos musculos retos com plicatura longitudinal mediana, feita entre dois clipes metalicos implantados. Os dois tipos de sutura foram realizados em todas as pacientes. No GST, apos a realizacao da sutura continua, foi realizada e mantida a sutura triangular e o oposto ocorreu no GSC. Apos cada sutura a distancia entre os clipes foi medida. Foram realizadas radiografias de abdome tres semanas e seis meses apos a cirurgia quando foi medida a distancia entre os clipes. Os dados foram comparados utilizando-se Analise de Variancia de Friedman e teste de Wilcoxon. Resultados: A sutura triangular promoveu reducao significante do eixo vertical da aponeurose quando comparada a sutura continua e a situacao sem sutura no periodo intraoperatorio (Wilcoxon p<0,001). Esta diferenca manteve-se nas radiografias de seis meses (Wilcoxon p<0,001). Conclusao: A sutura triangular produziu encurtamento do eixo vertical do plano musculo-aponeurotico da parede abdominal em longo prazo
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    Prevalência de artefatos em exames de ressonância magnética do abdome utilizando a seqüência GRASE: comparável com as melhores seqüências rápidas?
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2005-09-01) Francisco, Viviane Vieira [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Silva, Gláucia Palácio de Andrade E [UNIFESP]; Bezerra, Alexandre Sérgio de Araújo [UNIFESP]; Szejnfeld, Jacob [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To determine the overall frequency of artifacts per type and grade using the GRASE sequence in abdominal magnetic resonance; to compare GRASE sequences with two previously selected TSE sequences as well as sequences with best signal-noise ratio and lower incidence of artifacts. MATERIALS AND METHODS: A prospective self-paired study was carried out in 86 patients submitted to upper abdominal magnetic resonance using a GRASE sequence obtained upon respiratory triggered and fat suppression and six TSE T2-weighted sequences. Among the six TSE sequences, those bearing the best signal-noise ratio and lower number of artifacts were previously selected, which consisted of those performed with fat suppression and respiratory triggering: one using a conventional body coil (sequence 1) and a second sequence using a synergy coil (sequence 2). Image analysis was carried out by two observers upon consensus regarding the presence, grade and type of artifact thereon. Subsequently, data were statistically analyzed using the Friedman test and chi-square. RESULTS: The absolute frequency of artifacts in all sequences was 65.02%. Most common artifacts in the three sequences analyzed were breathing (30%) and pulsation (33%) artifacts. Only in 3% of the cases artifacts interfered with the analysis of the images. The frequency of artifacts in the different sequences was: GRASE, 67.2%; TSE sequence 1, 62.2%; TSE sequence 2, 65.5%. There was no significant statistical difference between artifact frequency seen with GRASE and TSE sequences (p = 0.845; NS). CONCLUSION: GRASE and TSE T2-weighted, respiratory triggered, fat suppressed sequences often produce artifacts, notwithstanding the coil, although, with similar frequency and generally without interfering with the evaluation of the images.
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    Seroma em lipoabdominoplastia e abdominoplastia convencional: estudo comparativo
    (Universidade Federal de São Paulo (UNIFESP), 2009-09-30) Di Martino, Marcello [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Abdominoplasty is one of the most frequently performed cosmetic procedures and its combination with liposuction has become more common. Seroma is one of the most common complications in abdominoplasty.Objective: To compare the rate of seroma formation in patients who underwent either abdominoplasty without the use of quilting sutures, or lipoabdominoplasty. Methods: The sample consisted of 41 female patients, who were divided into two groups and underwent one of the following procedures: group A (n=21), abdominoplasty without quilting sutures and group B (n=20), lipoabdominoplasty. In order to investigate seroma formation, abdominal ultrasound was performed in 5 regions of the abdominal wall [epigastrium (EPI), umbilical (UMB), hypogastrium (HYPO), right iliac fossa (RIF) and left iliac fossa (LIF)], at two postoperative periods: (P1), between postoperative days 11 and 14, and (P2), between postoperative days 18 and 21. Results: The rate of seroma formation P1 was 38,1% in group A and 10,0% in group B. In P2 the rate of seroma formation was 33,3% in group A and 0,0% in group B. It was observed that, in group A at P1, the regions RIF and LIF developed larger fluid collections. In group B, there were significantly larger fluid collections in the HYPO region at P1, and in the UMB and HYPO regions at P2. Conclusion: Lipoabdominoplasty is a effective techniques for the prevention of seromas compared with conventional abdominoplasty.
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    Seroma em lipoabdominoplastia e abdominoplastia: estudo ultrassonográfico comparativo
    (Sociedade Brasileira de Cirurgia Plástica, 2010-12-01) Di Martino, Marcello [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Novo, Neil Ferreira [UNIFESP]; Kimura, Alexandro Kenji; Ferreira, Lydia Masako [UNIFESP]; SBCP; Universidade Federal de São Paulo (UNIFESP); Universidade de Santo Amaro
    BACKGROUND: Seroma is one of the most common complications in abdominoplasty. OBJECTIVE: To compare the rate of seroma formation in patients who underwent either abdominoplasty and lipoabdominoplasty. METHODS: The sample consisted of 41 female patients, who were divided into three groups and underwent one of the following procedures: group A (n=21), abdominoplasty and group B (n=20), lipoabdominoplasty. In order to investigate seroma formation, abdominal ultrasound was performed in 5 regions of the abdominal wall [epigastrium (EPI), umbilical (UMB), hypogastrium (HYPO), right iliac fossa (RIF) and left iliac fossa (LIF)], at two postoperative periods: (P1), between postoperative days 11 and 14, and (P2), between postoperative days 18 and 21. RESULTS: The rate of seroma formation at both P1 and P2 was significantly higher in group A than in group B. It was observed that, in group A at P1, the regions RIF and LIF developed larger fluid collections. In group B, there were significantly larger fluid collections in the HYPO region at P1, and in the UMB and HYPO regions at P2. CONCLUSION: Lipoabdominoplasty is effective technique for the prevention of seroma compared with abdominoplasty.
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    Síntese da parede abdominal: avaliação de dois tipos de sutura contínua em ratos
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2003-06-01) Loureiro, Vanessa Medeiros [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Taha, Murched Omar [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To establish morphologic relationship between the continuous simple mass suture and the continuous far-near, near-far mass suture of longitudinal midline abdominal incision. METHODS: A total of 48 male Wistar rats underwent longitudinal standard laparotomy with equal distribution to one of two groups: GI- continuous simple mass suture, GII-continuous far-near, near-far suture, both with polypropylene. On postoperative day 7th or14th, 12 animals of each group were submitted to euthanasia and anterior abdominal wall was removed (without skin) for histologic and immune- histochemistry analysis. The samples of the abdominal wall were stained by hematoxylin-eosin in order to performed a qualitative healing tissue reaction. Others samples were stained by Picrosirius red F3BA in order to performed a quantitative analysis of macrophages and collagen. Statistical analysis was done by use the chi-square test, Fisher exact test and Mann-Whitney variance test ( p< 0,05). RESULTS: The findings of the macrophages cells and the collagen evaluation were statistical significantly on day 7th. CONCLUSION:The continuous far-near, near-far technique improved the abdominal wall healing on day 7th. On day 14th the findings were the same.
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    Síntese da parede abdominal: sutura contínua ou com pontos separados? Revisão da literatura
    (Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 1998-04-01) Tognini, João Ricardo F.; Goldenberg, Saul [UNIFESP]; Universidade Federal de Mato Grosso do Sul; Universidade Federal de São Paulo (UNIFESP)
    Nowadays , is belivied that the single-layer mass closure is better than the individual layer sutures, with less risk of complications. Although there is alot of materials to be used, the types preferable to be best used are the monofilament inabsorbable and the monofilament long-term absorbable suture. There still are doubts about abdominal closure using continuous or interrupted sutures. Different publications, with different methods and ways of valuation, conclude advantages for one or other technique, or conclude similar results. About these doubts, the authors relate the continuous and interrupted sutures on the abdominal wall closure, emphasizing the technical aspects.
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    O valor da fase sem contraste na tomografia computadorizada do abdome
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2008-10-01) Leite, Ana Paula Klautau [UNIFESP]; Mattos, Leandro Accardo de [UNIFESP]; Pinto, Gustavo Alfredo Duarte Henriques [UNIFESP]; Scaciota, Andrea Puchnick [UNIFESP]; Franco, Rita Maria Aparecida Monteiro Moura [UNIFESP]; Andreoni, Cássio [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To determine the role of the unenhanced phase of abdominal computed tomography in patients without a definite diagnosis or undergoing tumor staging. MATERIALS AND METHODS: A prospective and transversal study was developed with 100 consecutive patients submitted to unenhanced and contrast-enhanced abdominal computed tomography. Two observers evaluated all the computed tomography images in the contrast-enhanced phase (first analysis) and, later, in the unenhanced phase (second analysis) in an attempt to establish the primary and secondary diagnoses as a function of the clinical indication for the study. The frequency of changes in the diagnoses resulting from a combined analysis of the images in the pre- and post-contrast phases was evaluated. Cases with changes in the diagnosis were reviewed by clinical specialists for determining possible changes in the therapeutic approach. RESULTS: Primary and secondary diagnoses were changed in respectively 1 and 18 cases (p = 1.000; p = 0.143) as follows: steatosis, adrenal nodules, nephrolithiasis, renal cysts and hepatic calcification. In the cases where the unenhanced phase changed the diagnosis, the specialists changed the therapeutic approach in 14 of the 19 patients (73%) (p = 0.038). CONCLUSION: No significant change was observed in the primary or secondary diagnosis as a result of the findings in the unenhanced phase. However, changes in secondary diagnoses affected the therapeutic approach adopted by the specialists.
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    A variation in the component separation technique that preserves linea semilunaris: a study in cadavers and a clinical case
    (Elsevier B.V., 2010-03-01) Barbosa, Marcus Vinicius [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Oliveira Filho, Renato Santos de [UNIFESP]; Montecinos Ayaviri, Natalia Alinda [UNIFESP]; Novo, Neil Ferreira [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    The purpose of this study is to evaluate and compare the effect of the incision of the external oblique aponeurosis along the semilunaris in amount of tension present after the undermining of the anterior rectus sheaths. Forty fresh adult cadavers were studied and divided into two groups: group A (n = 20) and group B (n = 20). Traction indexes were compared in three situations: (1) before any aponeurotic undermining (similar on both groups); (2) after incision and undermining of the anterior rectus sheaths (similar on both groups) and (3) group A: after undermining of the external oblique muscles with the incision of their aponeurosis along the semilunaris and group B: undermining of a continuous layer of the anterior rectus sheaths and the external oblique aponeurosis, after release of the lateral aspect of the rectus sheaths. Significance of differences was assessed using non-parametric tests. There was a significant tension reduction after each stage of dissection in both supra-and infra-umbilical levels and on both groups. Comparisons between groups A and B did not show statistically significant differences in all sites and stages of the dissections. Therefore, both techniques showed similar aponeurotic tension reduction after each stage of the dissections in cadavers. (C) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier B.V. All rights reserved.
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    When the non-contrast-enhanced phase is unnecessary in abdominal computed tomography scans? A retrospective analysis of 244 cases
    (Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, 2013-07-01) Costa, Danilo Manuel Cerqueira; Salvadori, Priscila Silveira; Monjardim, Rodrigo da Fonseca; Bretas, Elisa Almeida Sathler; Torres, Lucas Rios; Caldana, Rogerio Pedreschi; Shigueoka, David Carlos [UNIFESP]; Medeiros, Regina Bitelli [UNIFESP]; D'Ippolito, Giuseppe [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Department of Diagnostic Imaging Department of Diagnostic Imaging
    Objective: To evaluate the necessity of the non contrast-enhanced phase in abdominal computed tomography scans. Materials and Methods: A retrospective, cross-sectional, observational study was developed, evaluating 244 consecutive abdominal computed tomography scans both with and without contrast injection. Initially, the contrast-enhanced images were analyzed (first analysis). Subsequently, the observers had access to the non-contrast-enhanced images for a second analysis. The primary and secondary diagnoses were established as a function of the clinical indications for each study (such as tumor staging, acute abdomen, investigation for abdominal collection and hepatocellular carcinoma, among others). Finally, the changes in the diagnoses resulting from the addition of the non-contrast-enhanced phase were evaluated. Results: Only one (0.4%; p > 0.999; non-statistically significant) out of the 244 reviewed cases had the diagnosis changed after the reading of non-contrast-enhanced images. As the secondary diagnoses are considered, 35 (14%) cases presented changes after the second analysis, as follows: nephrolithiasis (10%), steatosis (3%), adrenal nodule (0.7%) and cholelithiasis (0.3%). Conclusion: For the clinical indications of tumor staging, acute abdomen, investigation of abdominal collections and hepatocellular carcinoma, the non-contrast-enhanced phase can be excluded from abdominal computed tomography studies with no significant impact on the diagnosis.