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- ItemSomente MetadadadosAvaliação clínica e eletromanométrica em doentes portadores de megacolo chagásico submetido a sigmoidectomia associada a anoretomiectomia(Universidade Federal de São Paulo (UNIFESP), 1983) Matos, Delcio [UNIFESP]; Pan Chacon, Jesus [UNIFESP]
- ItemAcesso aberto (Open Access)Evaluation of the positioning of the tip of the Veress needle during creation of closed pneumoperitoneum in pigs(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2006-02-01) Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Sorbello, Albino Augusto [UNIFESP]; Silva, Cássio Edvan Paulino da [UNIFESP]; Azevedo, Otávio Cansanção [UNIFESP]; Aguiar-Yamaguchi, Gilmara Silva [UNIFESP]; Menezes, Francisco Julimar Correia de [UNIFESP]; Delorenzo, Aline [UNIFESP]; Pasqualin, Rubens Campana [UNIFESP]; Kozu, Fábio Okutani [UNIFESP]; EAES; Universidade Federal de São Paulo (UNIFESP); HSPE Division of LaparoscopyPURPOSE: Erroneous punctures and insufflations are frequent with the use of the Veress needle. Mistaken injections of gas in the preperitoneal space are not rare. The purpose of this research is to evaluate the correct positioning of the tip of the needle during creation of pneumoperitoneum. METHODS: The needle was inserted into the peritoneal cavity. Tests to assess the positioning of the needle tip were carried out. Pressure, flow rate and volume were periodically recorded and the needle was removed, being immediately reinserted into the right hypochondrium and placed in the preperitoneal space. RESULTS: The liquid flow test was always positive in the peritoneal cavity. No resistance to saline injection into the peritoneal cavity was observed, but increased resistance to saline injection into the preperitoneal space was observed in 45.5% of the cases. Some saline was recovered in 63.5% of the cases in the peritoneal cavity, and in 54.5% in the preperitoneal space. Saline drop test was positive in 66.6% of the cases in the peritoneal cavity and in 45.5% in the preperitoneal space. In the peritoneal cavity, initial pressure lower than 5 mm Hg was observed, and this pressure gradually increased during 123 seconds until reaching 15 mm Hg. In the preperitoneal space, initial pressure was 15 mm Hg. CONCLUSIONS: Aspiration, liquid flow and saline drop tests are important, whereas recovery test is inconclusive. Initial pressure of approximately 5 mm Hg indicates that the tip of the needle is in the peritoneal cavity. The peritoneal cavity should hold ten times as much volume of gas as the preperitoneal space. The increase in pressure and volume in the peritoneal cavity can be predicted by statistics.
- ItemAcesso aberto (Open Access)Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures(Sociedade Brasileira de Ortopedia e Traumatologia, 2014-01-01) Zogaib, Rodrigo Kallás; Morgan, Steven; Belangero, Paulo Santoro; Fernandes, Hélio Jorge Alvachian; Belangero, William Dias; Livani, Bruno; Universidade Estadual de Campinas (UNICAMP); Swedish Medical Center; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique.METHODS:Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures.RESULTS:In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury.CONCLUSION:It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft.Level of Evidence III, Therapeutic Study.
- ItemAcesso aberto (Open Access)Opções técnicas utilizadas no transplante pancreático em centros brasileiros(Colégio Brasileiro de Cirurgiões, 2005-02-01) Gonzalez, Adriano Miziara [UNIFESP]; Lopes Filho, Gaspar de Jesus [UNIFESP]; Triviño, Tarcísio [UNIFESP]; Messetti, Fabrízio [UNIFESP]; Rangel, Erika Bevilaqua [UNIFESP]; Melaragno, Claudio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: To analyze the profile of the most important Brazilian Transplant Centers regarding technical options in the pancreas transplant. METHODS: A query was sent by electronic mail for the 12 Brazilian Transplant Centers with at least one pancreas transplant performed. The query included ten questions approaching controversial and non-standard technical aspects. RESULTS: Midline abdominal incision is used in 90.9% of the Centers. The first organ to be implanted is the kidney in 63% of the Centers. Regarding the venous drainage, 90.9% perform systemic drainage. In 54.5% of the Centers the internal iliac vein is ligated. For combined pancreas-kidney transplant 90.9% of the teams perform enteric drainage. Five Centers answered about isolated pancreas transplant, two of them use enteric drainage and the other three prefer to utilize the bladder. 63% of the surgical teams use abdominal drain. 72.7% of the Centers adopt immunosupression induction for the combined pancreas-kidney transplant. The basic immunosuppression was an association between tacrolimus (FK506), and mofetil microfenolato (MMF), and corticoids. While antibiotic prophylaxis is performed in all the 12 Centers, fungus prophylaxis is routinely made in six of them. Eight Centers (72.7%) adopt vascular thrombosis prophylaxis by several different protocols. CONCLUSION: There are various technical medical protocols on how to conduct a pancreas transplant patient. The lack of homogeneity in the protocols makes it more difficult to analyze and compare the results. Nevertheless we can conclude that in combined pancreas-kidney transplant there is a preference towards midline abdominal incision, and vein systemic and enteric drainage, and vascular thrombosis prophylaxis.
- ItemAcesso aberto (Open Access)Parâmetros eficientes do posicionamento adequado da ponta da agulha de veress durante o estabelecimento de pneumoperitônio(Colégio Brasileiro de Cirurgiões, 2006-08-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto [UNIFESP]; Miguel, Gustavo Peixoto Soares [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Godoy, Antônio Cláudio de; Hospital do Servidor Público do Estado de São Paulo Serviço de Gastroenterologia Cirúrgica; Universidade Federal de São Paulo (UNIFESP); Universidade de Lyon; Hospital do Servidor Público do Estado de São Paulo Setor de VideocirurgiaBACKGROUND: To evaluate the possibility of establishing reliable parameters for the appropriate positioning of Veress needle tip in the peritoneal cavity during pneumoperitoneum creation. METHODS: In 100 selected patients Veress needle tip were introduced in the peritoneal cavity and the insufflators were programmed for a flow of 1,2L/min and with final maximum pressure of 12mmHg. At the beginning of the insufflation and at every 20 seconds the intraperitoneal pressure (IP) and the total volume injected (TVI) were recorded. Data was treated by statistical correlation between moments and IP, and moments and TVI. The forecast values of IP and TVI at the end of each one of the four first insufflation minutes were also established, using the following estimated formulas: IP = 2.3083 + 0.0266 x time + 8.3x10-5 x time³ - 2.44x10-7 x time³; TVI = 0.813 + 0.0157 x time. RESULTS: IP and TVI showed a correlation between pre-established moments of pneumoperitoneum creation when a strong adjustment became apparent: IP = -2E - 07 x time³ + 8E - 05 x time² + 0.0266 x time + 2.3083, with a coefficient of explanation: (R2) = 0.8011; TVI = 0.0157 x time + 0.1813, with R2=0.9604. The forecast of IP and TVI showed: IP (mmHg): 1min=4.15; 2 min=6.27; 3 min=8.36; 4 min=10.10 and TVI (L): 1min=1.12; 2 min=2.07; 3 min=3.01; 4 min=3.95. CONCLUSION: Reliable parameters for IP and TVI can be established during pneumoperitoneum creation when the Veress needle tip is located in the peritoneal cavity in a given insufflation moment.
- ItemAcesso aberto (Open Access)Tratamento cirúrgico da distopia de parede vaginal anterior: comparação entre tela biológica e colporrafia tradicional(Universidade Federal de São Paulo (UNIFESP), 2010-11-25) Feldner Junior, Paulo Cezar [UNIFESP]; Girão, Manoel João Batista Castello [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: the aim of this study was to evaluate anatomical, functional results and complications of small intestine submucosa (SIS) graft compared to traditional anterior repair in surgical treatment of anterior vaginal wall prolapse. Methods: This is a randomized and prospective study to compare the SIS graft with traditional colporrhaphy (TC) in surgical treatment of anterior vaginal prolapse. Subjects were randomized to SIS (n=29) or to TC (n=27) and compared preoperatively and at 6 months postoperatively. We used pelvic organ quantification system (POP-Q), a validated prolapse quality of life questionnaire (P-QoL) and possible complications. Data were compared using the Mann–Whitney test or a chi-squared test to determine that there were no significant intergroup differences. This then enabled us to use the independent samples t-test or the paired Student’s t-test. This study was approved by Local Ethics Committee and register at ClinicalTrials NCT00827528. Results: the outcomes represent the analysis of 29 patients in SIS group and 27 in traditional repair. Both groups were paired by age, parity, body mass index, stage of anterior prolapse, previous surgery for prolapse, presence of incontinence, POP-Q measurements and quality of life preoperatively. At 6-month follow-up, SIS group have 86.2% anatomic cure comparing with 59.3% in traditional repair, using the International Continence Society (ICS) patterns. We did not report differences between the techniques when we divided the stage II. The mean point Ba preoperatively in SIS group was +2.07 cm and +2.22 cm in traditional repair and postoperatively -1.93 cm (p<0.001) and -1.37 cm (p<0.001), respectively. The NNT (Number Need to Treat) was 4. Both operations significantly improved prolapse quality-of-life severity measures. Although SIS group did not showed significant improvement in quality-of-life parameters measured in comparison to traditional repair. Excessive bleeding occurred in 4 patients in SIS group although none required blood transfusion. We reported more complications in SIS group (20 vs 9, p=0.01) and longer surgical time (48.3min ±16.1 vs 30.3min ±19.4; p=0.001). The average hospital length was 3.3 and 3.2 days, respectively. We did not reported infections or erosion of the mesh. Conclusions: Surgery for vaginal prolapse results in marked improvement in prolapse quality of life. We could see that SIS repair improved point Ba measurement significantly using the ICS patterns. Regarding quality-of-life parameters we did not observe significant differences in both techniques.
- ItemAcesso aberto (Open Access)Trends in treatment of anterior cruciate ligament injuries of the knee in the public and private healthcare systems of Brazil(Associação Paulista de Medicina - APM, 2013-01-01) Astur, Diego Costa; Batista, Rodrigo Ferreira; Arliani, Gustavo Goncalves; Cohen, Moises [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding treatment of a damaged anterior cruciate ligament, which is a common knee injury. DESIGN AND SETTING Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. CONCLUSION Both in the public and in the private systems in Brazil, because of non-medical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians.
- ItemAcesso aberto (Open Access)Valor das provas de posicionamento da ponta da agulha de veress em punção do hipocôndrio esquerdo na instalação do pneumoperitônio(Colégio Brasileiro de Cirurgiões, 2006-10-01) Azevedo, Otávio Cansanção [UNIFESP]; Azevedo, João Luiz Moreira Coutinho [UNIFESP]; Sorbello, Albino Augusto; Miguel, Gustavo Peixoto Soares [UNIFESP]; Guindalini, Rodrigo Santa Cruz [UNIFESP]; Godoy, Antônio Cláudio de; Hospital do Servidor Público do Estado de São Paulo Serviço de Gastroenterologia Cirúrgica; Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público do Estado de São Paulo Setor de VideocirurgiaBACKGROUND: To evaluate tests for Veress needle tip placement intraperitoneally in the left hypochondrium for creating a pneumoperitoneum. METHODS: Needle tip placement tests were evaluated in one hundred patients using the left hypochondrium area. It was considered positive when: aspiration test (PA) -returned organic material; resistance test (PRes) - a low pressure was pushed on the syringe for the liquid infusion; recovery test (PRec) - no liquid was recovered after infusion; dripping test (PG) - drops drained quickly; test for initial intraperitoneal pressure (PPII) - levels were <= 8mmHg. Positive PA suggested bowel injury, while positive PRes, PRec, PG and PPII indicated that needle tip was adequately located in the peritoneal cavity. The Sensitivity ( SE) and Specificity ( SP ), as well as their predictive positive values (PPV) and predictive negative values ( PNV) of these tests were calculated using results correlation which were true-positives (a), false-positives (b), false-negatives (c) and true-negatives (d), accordingly to the formulas: SE =[a/ (a+c)]x100; SP =[d/(b+d)]x100; PPV=[a/(a+b)]x100; PNV=[d(c+d)]x100. RESULTS: If a positive PA had returned, SE and PPV did not fit, and SP=100% and PNV =100%. In the PRes, SE =0%, SP =100%, PPV = did not exist and PNV =90%. Both in the PRec and in the PG, results were for SE =50%, SP =100%, PPV =100% and PNV =94.7%. In the PPII test results were for SE, PPV and PNV =100%. CONCLUSION: Left hypochondrium negative PA guaranteed that bowel was not perforated; PRes test is a not accurate test for detection of the needle tip bad placement, however it accurately indicates its good positioning; PRec and the PG tests do not detect the adequate positioning, but they detect very well the inadequate positioning; PPII test shows with reliability both bad and good positioning of the needle, being the most trustworthy test among those studied.