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- ItemAcesso aberto (Open Access)Alterações radiográficas do tálus no pé torto congênito após liberação cirúrgica pela técnica de McKay(Sociedade Brasileira de Ortopedia e Traumatologia, 2010-12-01) Pinto, Jose Antonio [UNIFESP]; Hernandes, Andréa Canizares [UNIFESP]; Buchaim, Thais de Paula [UNIFESP]; Blumetti, Francesco Camara [UNIFESP]; Chertman, Carla [UNIFESP]; Yamane, Patrícia Corey [UNIFESP]; Fernandes, Artur da Rocha Correa [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To analyze the morphologic changes of the talus after surgical treatment of congenital clubfoot using the McKay procedure. METHODS: We retrospectively analyzed lateral standing radiographs of the feet in 14 patients with unilateral clubfoot treated by the McKay procedure. All patients were operated on by the same surgeon, with an average of 6.53 years between surgery and the radiograph. We compared the characteristics of the talus between the operated foot and the contralateral foot. We evaluated the deformity of the domus and the head of the talus (sphericity evaluation), the talar length and height, the presence and percentage of navicular subluxation, changes in the Gissane angle, and the trabecular pattern of the bone. RESULTS: Deformities of the head of the talus were observed in 92.8% of the patients; of the domus in 92.8%; and of the trabecular pattern in 100%. The ratio between the talar lengths of the operated foot and the contralateral foot ranged from 0.61 to 0.88 (Mean 0.79, SD = 0.09), while the height ratio ranged from 0.57 to 0.98 (Mean 0.82, SD = 0.12). The Gissane angle was increased in all of the operated feet, which also showed some degree of navicular subluxation, ranging from 6.43 to 59.75% (Mean 26.34%, SD = 16.66%). CONCLUSIONS: Abnormal talar findings were observed in 100% of the feet treated using the McKay procedure. The establishment of radiographic parameters to describe and quantify these deformities was feasible through simple and easy techniques.
- ItemAcesso aberto (Open Access)Avaliação da técnica de epifisiodese temporária com o uso das placas de Sherman: resultados preliminares(Sociedade Brasileira de Ortopedia e Traumatologia, 2010-12-01) Pinto, Jose Antonio [UNIFESP]; Christiano, Eduardo Suñe [UNIFESP]; Sanchez, Gustavo Tadeu [UNIFESP]; Blumetti, Francesco Camara [UNIFESP]; Dobashi, Eiffel Tsuyoshi [UNIFESP]; Pinto, Bruno Luis Moraes; Universidade Federal de São Paulo (UNIFESP); Universidade Nove de Julho de São Paulo MedicinaOBJECTIVE: To evaluate the preliminary results of a technique using temporary epiphysiodesis plates using a Sherman plate in the treatment of disorders and deformities of the lower limbs. METHODS: We retrospectively reviewed 27 patients who underwent temporary epiphysiodesis of the distal femur or proximal tibia with Sherman plates, comprising 28 procedures. The mean age at surgery was 11.2 years (3-15 years). The two-hole plates were made of steel alloy and had a central hole to be used as a guide. The fixation was performed with two 3.5 mm cannulated screws. Indications for treatment were the angular deviations of the lower limbs in valgus (n = 10), varus (n = 2) and mixed (n = 1), limb length discrepancy (n = 9), and the flexion contracture of the knee (n = 5). RESULTS: The mean follow-up period was 11.78 months (± 4.07). We observed only one adverse event (migration of the implant) in a patient who underwent anterior epiphysiodesis of the distal femur for the correction of knee flexion. There were no cases of equipment failure or premature physeal closure. CONCLUSION: The temporary epiphysiodesis procedure using the Sherman plates proved to be easy to execute and was involved with a low rate of complications and lower cost than similar titanium implants. Because it is a procedure with low morbidity, this surgical technique may be indicated for a wide age range and for a variety of disorders of the immature skeleton.
- ItemSomente MetadadadosContribuição ao estudo do material resultante do tratamento de neoplasias intra-epitelias cervicais (NIC), pelo método de cirurgia e alta frequência (CAF)(Universidade Federal de São Paulo (UNIFESP), 1999) Souza, Antonio Francisco de [UNIFESP]; Stávale, João Norberto [UNIFESP]O presente trabalho representa uma contribuição ao estudo morfológico de 683 casos de materiais de colo uterino resultantes de cirurgia de alta freqüência (CAF), comparando, quando possível, com os resultados citológicos e/ou histológicos prévios. Esse material de estudo foi obtido pela equipe do serviço de Genecologia (cirurgia ambulatorial e dos blocos cirúrgicos) dos hospitais Instituto João Resende Alves (IJRA), hoje Hospital Luxemburgo, e Hospital Mário Penna e processado no Departamento de Anatomia Patológica e Citopatologia, também desses hospitais. Os materiais resultantes das CAF foram estabilizados em fixador de rotina em anatomia patológica (formalina a 1O por cento) e seu tratamento químico realizado em Processador automático de tecidos. Todo o material cirúrgico foi processado e incluído em blocos de gl parafina, sendo confeccionadas lâminas com cortes escalonados de 5 micras, que foram submetidas à coloração pelo método de hematoxilina-eosina (HE). Os dados analisados incluíram a idade das pacientes, diagnósticos prévios citológicos e histológicos, condições macroscópicas do material resultante da CAF (se removido por excisão cônica ou se obtido por múltiplas excisões), profundidade da exérese, diagnóstico realizado, condições das margens cirúrgicas (anterior e posterior), curetagem pós-CAF do coto de colo remanescente, integridade das alterações morfológicas nas lesões estudadas, alterações tissulares promovidas pelo efeito térmico e seu grau de interferência no diagnóstico histológico.
- ItemAcesso aberto (Open Access)Effects of preoperative irradiation using fractioned electron beam on the healing process of colocolonic anastomosis in rats undergoing early and late surgical intervention(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2013-01-01) Simões Neto, Joaquim [UNIFESP]; Reis Neto, José Alfredo Dos; Matos, Delcio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); PUCCAMP Department of Surgery; Metropolitan University of SantosPURPOSE: To investigate the effects of preoperative fractioned irradiation using an electron beam on the healing process of colocolonic anastomoses in rats that underwent early and late surgical intervention. METHODS: Thirty Wistar rats, distributed as follows: group A (surgery only), group B (fractionated irradiation for 30 days (if), surgery seven days after the end of it), group C (if for 30 days, and surgery after 30 days of termination). On the seventh postoperative day the anastomotic segment analysis was taken, using tension tests, histology and collagen deposition evaluation by computerized analysis. RESULTS: Regarding the tension resistance of the anastomosis, there were no statistical differences (p=0.42). However, a significant increase in cells number in the inflammatory infiltrate in the group with a longer interval between surgery and pre op radiation (p<0.05). The collagen concentration had no significant variance. CONCLUSION: The irradiation in divided doses increased local inflammatory cellularity when the surgery was performed later. This result did not affect the increase of complications, nor on the local concentration of collagen, achieving similar clinical outcomes.
- ItemAcesso aberto (Open Access)Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-12-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Wilson Junior, Jorge Luis [UNIFESP]; Godoy, Antônio Cláudio de; Universidade Federal de São Paulo (UNIFESP); HSPE Service of Surgical Gastroenterology Division of Laparoscopy; HSPE Service of Surgical GastroenterologyPURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.
- ItemAcesso aberto (Open Access)Fixação intramedular das fraturas do fêmur na infância e na adolescência com hastes flexíveis(Sociedade Brasileira de Ortopedia e Traumatologia, 2011-01-01) Janovsky, César [UNIFESP]; Aoyagui, Alexandre Yoiti [UNIFESP]; Pierami, Rafael [UNIFESP]; Saad, Eduardo Abdalla [UNIFESP]; Dobashi, Eiffel Tsuyoshi [UNIFESP]; Pinto, Jose Antonio [UNIFESP]; Milani, Carlo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: to evaluate the surgical treatment results using intramedullary retrograde Ender nails in isolated unilateral femur fractures. Methods: the authors performed a retrospective study of 31 patients (32 femurs), 22 (71%) males and 9 (29%) females with the mean age of 11,3 years (8 to 16 years old). According to the trauma mechanism we observed: 13 (42%) car accidents, 5 (16%) motorcycle accidents, 4 (13,%) running over accidents, 6 (19 %) falls from height and 3(10%) bicycle falls. The follow up varied from 1,6 to 6,3 years (average of 2,7 years). The period of hospitalization was 6,81 days varying from 3 to 19 days. After 1 year we performed clinical evaluation (pain, range of motion, gait) and scanogram do evaluate LDD. Results: We obtained 28 (90,3%) satisfactory and 3 (9,6%) unsatisfactory results. The following complications were recognized: LLD in 8 (25,8%), pain 2(6,4%), limited range of knee flexion in 1 (3,2,%) patients. Conclusions: the authors still consider small the population studied although the higher rate of satisfactory results. The treatment with Ender nails was effective, safe, unexpensive and can be indicated to treat isolated stable femur fractures.
- ItemSomente MetadadadosIntegration of collagen matrices into the urethra when implanted as onlay graft(Brazilian Soc Urol, 2013-05-01) Sayeg, Kleber [UNIFESP]; Freitas-Filho, Luiz G. [UNIFESP]; Waitzberg, Angela Flavia Logullo [UNIFESP]; Arias, Victor Eduardo Arrua [UNIFESP]; Laks, Marcus [UNIFESP]; Egydio, Fernanda Mattos [UNIFESP]; Oliveira, Andreia Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To assess the integration of decellularized heterologous collagen matrices into the urethra, when implanted with no cells or when seeded with autologous smooth muscle cells.Materials and Methods: Eighteen New Zealand rabbits were randomly assigned to two groups: Group I (n = 9) - animals undergoing urethral segment resection with interposition of a patch of heterologous collagen matrix seeded with autologous smooth muscle cells; Group II (n = 9) - animals undergoing resection of a urethral segment with interposition of a decellularized heterologous collagen matrix patch. Two animals from each group were sacrificed on postoperative days seven, fourteen and twenty-eight; three animals from each group were sacrificed at the end of three postoperative months. At the end of the third month one animal from each group underwent urethroscopy for urethral integrity assessment and one animal from each group had its microcirculation image captured by a SDF device (Side-stream Dark Field - Microscan Analysis Software). One animal from each group in each euthanasia period underwent cystourethrography so as the urethra could be viewed at flow time. the matrices integration was assessed through histological examination using hematoxylin and eosin (H&E), Masson trichrome (MT), Picrosirius red and Von Willebrand staining. in a blind study with two pathologists all the slides were studied.Results: the matrices whether seeded or not with autologous muscle cells were able to restore the architecture of the urethra, but were eliminated from the first week on, before incorporation. Microcirculation of the neourethra, at the end of the third month, showed the same characteristics as a normal urethra in both groups of animals.Conclusion: Natural heterologous matrices implanted in the urethra as onlay graft were not incorporated into its walls but were able to fully restore the cell architecture of the organ, regardless of being seeded or not with autologous muscle cells.
- ItemSomente MetadadadosRessecçõoes hepáticas menores - segmentectomias- no tratamento das lesões focais do fígado: técnicas e resultados(Universidade Federal de São Paulo (UNIFESP), 2001) Triviño, Tarcisio [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]A cirurgia hepatica teve nos ultimos 50 anos seu maior desenvolvimento e consolidacao. O transplante veio solucionara problema das doencas difusas do figado, restando desafio do tratamento das lesoes focais. Estando as hepatectomias classica ou resseccoes maiores reservadas a lesoes unilaterais em figados com funcao preservada passou-se a estimular as resseccoes menores, anatomicas, realizadas segundo a segmentacao proposta por Couinaud, tambem conhecidas por segmentectomias. Estas resseccoes podem ser realizadas em figados cirroticos, em lesoes bilaterais, multiplas e mesmo sincronicas. Na elaboracao deste trabalho, foi nosso objetivo rever a anatomia cirurgica do figado, bem como as tecnicas das principais segmentectomias, estudos estes desenvolvidos em pecas de cadaveres frescos. Como complemento, revimos retrospectivamente 42 doentes submetidos as mais diferentes segmentectomias, pelo mesmo cirurgiao, tendo por, indicacao doencas nao neoplasicas, neoplasias benignas, neoplasias malignas primarias, principalmente o hepatocarcinoma em cirroticos e neoplasias metastaticas colorretais e nao colorretais. Analisamos as complicacoes intra e pos-operatorias bem como a evolucao tardia. Da analise dos nossos resultados e do confronto com os dados da literatura, concluimos que as segmentectomias tem baixos indices de morbidade e mortalidade, ampliando as indicacoes das resseccoes hepaticas; sao curativas, n benignas; apesar da maior morbidade, podem ser uteis na terapeutica do hepatocarcinoma em figados cirroticos, atuando como ponte para o transplante hepatico e, finalmente, no tratamento das metastases hepaticas podem oferecer perspectiva de cura ou, pelo menos, aumento no tempo de sobrevida com qualidadeo tratamento das lesoes nao neoplasicas e neoplasias
- ItemSomente MetadadadosSingle scrotal incision orchiopexy - a systematic review(Brazilian Soc Urol, 2013-05-01) Novaes, Hugo Fabiano Fernandes [UNIFESP]; Carneiro Neto, Jose Abraao [UNIFESP]; Macedo, Antonio [UNIFESP]; Barroso Junior, Ubirajara [UNIFESP]; Universidade Federal da Bahia (UFBA); Universidade Federal de São Paulo (UNIFESP)Objective: To conduct a systematic review on single scrotal incision orchiopexy. Materials and Methods: A search was performed using Pubmed, through which 16 articles were selected out of a total of 133. the following conditions were considered exclusion criteria: other surgical methods such as an inguinal procedure or a laparoscopic approach, retractile testes, or patients with previous testicular or inguinal surgery.Results: A total of 1558 orchiopexy surgeries initiated with a transcrotal incision were analyzed. Patients' ages ranged between 5 months and 21 years. Thirteen studies used high scrotal incisions, and low scrotal incisions were performed in the remainder of the studies. in 55 cases (3.53%), there was a need for inguinal incision. Recurrence was observed in 9 cases, testicular atrophy in 3, testicular hypotrophy in 2, and surgical site infections in 13 cases. High efficacy rates were observed, varying between 88% and 100%.Conclusions: Single scrotal incision orchiopexy proved to be an effective technique and is associated with low rates of complications.