Repositório Institucional - Unifesp :: Navegando por Palavras-chave "cirurgia"

Navegando por Palavras-chave "cirurgia"

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Acesso endoscópico para tratamento de mucoceles fronto-etmoidais
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2002-05-01) Santos, Rodrigo P.; Barbosa, Luiz H. F.; Belfort, Marco A; Ferri, Ricardo Gimenes [UNIFESP]; Gregório, Luiz Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: The mucocele is an expansive benign tumor due to the filling of a closed cavity with mucus. Frequently involving the fronto-ethmoidal sinus, it is a rare otolaryngological condition. The etiology is divided into inflammatory and obstructive causes. Aim: To evaluate the endoscopic endonasal surgical approach for fronto-ethmoidal sinus mucoceles. Study design: Clinical prospective. Material and method: Thirteen patients were followed during the period of January of 2000 to April of 2001, regarding the clinical findings, evolution and surgical results. Results: All patients presented proptosis as the major symptom. Seven patients had the inflammatory form and two the obstructive one. Two patients presented ophthalmologic complications and underwent orbital decompression associated with the endoscopic endonasal technique. There were no recurrences in our study. Conclusions: The endoscopic endonasal approach for fronto-ethmoidal sinus mucoceles is an effective treatment for the disease, avoiding the complications of the early techniques.
Acesso aberto (Open Access)
Adenoma folicular em cisto tireoglosso
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-06-01) Dedivitis, Rogério Aparecido [UNIFESP]; Lima, Fábio Rocha; Guirado, Cristiano Rosa; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Hospital Ana Costa Serviço de Anatomia Patológica; Centro Médico Aquino
Acesso aberto (Open Access)
Anestesia para tratamento intraparto extraútero (EXIT) em fetos com diagnóstico pré-natal de malformações cervical e oral: relato de casos
(Sociedade Brasileira de Anestesiologia, 2012-06-01) Helfer, Daniel Corrêa [UNIFESP]; Clivatti, Jefferson [UNIFESP]; Yamashita, Américo Massafuni [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
BACKGROUND AND OBJECTIVES: Fetus prenatally diagnosed with neck tumors, or with any other disease that obstructs the airways, should not be treated conventionally, as the assistant physician has to face two challenges right after the infant's delivery: the limited time to establish the access to the potentially difficult airways and the lack of anesthesia of the neonate in case of instrumentation of the airways. The ex utero intrapartum treatment, i.e., the EXIT procedure consists of maintaining the fetoplacental circulation during the cesarean section, until the airways of the fetus be secured. CASE REPORTS: Female patient, 37 years old, G3P2, 38 weeks pregnant, having polyhydramnios and fetus diagnosed with large cervical masses by prenatal ultrasound. A cesarean section was performed using the EXIT procedure to enable safe access to the infant's airways. After hysterotomy, the fetus was intubated by direct laryngoscopy. The neonate was immediately transferred to another operating room, where cervical tumor resection of the neck tumor and tracheostomy were successfully performed. Female patient, 27 years old, G3P1A1, 32 weeks pregnant, whose fetus was prenatally diagnosed with a large oral tumor. As the tumor obstructed the fetus' airways, a tracheostomy was performed when the fetus underwent EXIT procedure. It was then possible to use direct laryngoscopy for neonate intubation. The fetus underwent tumor resection and was sent to the Neonatal Intensive Care Unit. CONCLUSIONS: Reports describe the successful use of general anesthesia with isoflurane for cesarean delivery followed by the EXIT procedure in fetus diagnosed with tumors obstructing the airways.
Acesso aberto (Open Access)
Avaliação crítica de 33 pacientes com bócio mergulhante tratados cirurgicamente por cervicotomia
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2009-04-01) Neves, Murilo Catafesta das [UNIFESP]; Rosano, Marcello [UNIFESP]; Hojaij, Flávio Carneiro [UNIFESP]; Abrahão, Márcio [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Andreoni, Danielle Macellaro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The possibility of needing a combined access, with neck and chest incisions makes the treatment of substernal goiter a challenge both in the pre-op and the intraoperative. We hereby, discuss a standardization of the surgical technique to minimize the need for a chest approach, making the substernal goiter a surgically treatable disease, through a single neck incision, and with low indices of complication. AIM: to assess the substernal goiter surgically approach through a neck incision and to analyze the surgical complications. MATERIALS AND METHODS: we carried out a historical cohort by retrospective analysis of the charts of patients submitted to thyroidectomy, and 33 of them (10.4%) had substernal goiter. RESULTS: all 33 patients were surgically treated through a neck incision without the need for sternotomy. We did not observe definitive lesions in the inferior laryngeal nerve or definitive hypoparathyroidism. Only 2 patients had recurrent nerve paresis; and 2 patients were re-operated because of a neck hematoma. CONCLUSION: patients with substernal goiter can be safely treated surgically through a single neck incision, bearing low complication rates.
Acesso aberto (Open Access)
Avaliação da técnica de indução em sequência rápida dos anestesiologistas de um hospital universitário
(Sociedade Brasileira de Anestesiologia, 2012-06-01) Guirro, Ursula Bueno do Prado; Martins, Cesar Romão; Munechika, Masashi [UNIFESP]; Universidade Federal do Paraná Hospital do Trabalhador; SAMMEDI CET Hospital do Servidor Público Estadual de São Paulo; Universidade Federal de São Paulo (UNIFESP)
BACKGROUND AND OBJECTIVES: The induction of the general anesthesia in patients on a full stomach can result in regurgitation of the gastric content and pulmonary aspiration. The function of the rapid sequence induction (RSI) is to minimize the time interval between the loss of the airway protection reflexes and tracheal intubation tube balloon. The objective of this study was to evaluate the rapid sequence induction among the anesthesiologists of the São Paulo Hospital. METHODS: The participants answered the questionnaire voluntarily and anonymously, after signed consent. The questionnaire consisted of 60 questions about the fundamental points of the RSI. The questions were divided in pre-oxygenation, circuits, drugs used in the induction (opioids, hypnotics, neuromuscular blockers), cricoid pressure techniques, intubation and difficult intubation. RESULTS: Seventy-five questionnaires were applied and 22 were discarded due to incomplete answering. All anesthesiologists always declare doing pre-oxygenation and administering opioid, hypnotic, and neuromuscular blocker. Most use fentanyl (83%), propofol (74.5%) and succinylcoline (68.6%). All anesthesiologists apply cricoid pressure. Most did not know the correct pressure to be applied on the cricoid cartilage. Intubation failures have already occurred with 71.7% of anesthesiologists and with 40%, the regurgitation. When faced with an unexpected difficult intubation, anesthesiologists ask for the laryngeal mask (35.5%). CONCLUSIONS: This study showed a broad individual variety of the RSI technique, a fact already reported by different authors. The difficulty in establishing a RSI protocol can be attributed to constant evidence that science provides us, where updating over the years becomes good medical practice.
Acesso aberto (Open Access)
Comparação entre a telelaringoscopia e a laringoscopia de suspensão no diagnóstico das lesões benignas das pregas vocais
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2008-12-01) Mendes Neto, José Arruda [UNIFESP]; Pinna, Bruno Resende [UNIFESP]; Caporrino Neto, José [UNIFESP]; Pedroso, José Eduardo De Sá [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Proper diagnosis of laryngeal benign lesions still brings doubts among experienced laryngologists, despite current diagnostic progress. AIM: the goal of this study was to compare telelaryngoscopy (preoperative) with suspension laryngoscopy (intraoperative) on the diagnosis of vocal fold benign lesions. MATERIALS AND METHODS: We carried out a restrospective study analyzing 79 charts from patients followed up in a University Hospital. In all the charts there was at least diagnostic hypothesis suggested by telelaryngoscopy, which was later on compared to intraoperative findings of suspension laryngoscopy. RESULTS: Almost two-thirds of the patients were females, with ages varying between 12 and 66 years (mean of 37 years). Of the 79 patients studied, we diagnosed 95 lesions with telelaryngoscopy and 124 with suspension laryngoscopy. The most frequently found benign lesion was the vocal polyp in both methods. In 64.5% of the cases the diagnosis of the lesions in the outpatient ward was the same as those in the surgical findings. CONCLUSION: Laryngologists must be prepared to alter their surgical planning and treatment approaches because of diagnostic changes that may happen during surgery.
Acesso aberto (Open Access)
Employment and quality of life in mesial temporal lobe epilepsy with hippocampal sclerosis: is there a change after surgical treatment?
(Liga Brasileira de Epilepsia (LBE), 2009-06-01) Alonso, Neide Barreira [UNIFESP]; Azevedo, Auro Mauro [UNIFESP]; Centeno, Ricardo Silva [UNIFESP]; Guilhoto, Laura Maria de Figueiredo Ferreira [UNIFESP]; Caboclo, Luís Otávio Sales Ferreira [UNIFESP]; Yacubian, Elza Márcia Targas [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
PURPOSE: The aim of this study was to evaluate in patients with mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS): (1) employment patterns before and three years after epilepsy surgery and their impact in Quality of Life (QOL); (2) demographic and clinical variables associated with employment. METHODS: Data from 58 patients with diagnosis of refractory MTLE with HS who had corticoamygdalo-hippocampectomy were analyzed. The subjects answered to Brazilian validated version of the Epilepsy Surgery Inventory (ESI-55) before, and three years after surgery. In a semi-structured interview, sociodemographic and clinical characteristics were obtained. Changes in employment after surgery were classified in one of the three categories: (i) improvement status: those who were unemployed, no-formal employed, students, housewives and subjects who have never worked to employed category; (ii) unchanged status: no change in occupation; this category included subjects who were employed before and after the surgery, housewives, students, and the group who remained unemployed, receiving ill-health benefits or retired after the surgical treatment; and (iii) worsened status: loss of employment. RESULTS: Employment status did not show any significant change after surgery: in 51(87.9%) it remained unchanged, in six (10.3%) it improved, and one patient (1.7%), who was employed before the surgery, retired after that. In a subgroup of 22 patients employed after surgery, ten (45.5%) were seizure-free, seven (31.8%) had only rare auras, and five (22.7%) had seizures. In the group of improvement, 12 patients (70.5%) had no-formal employment and five (29.5%) had a formal job before surgery. After three years, 14 (63.6%) of 22 subjects were formally employed. Our data suggested that the employability was strongly correlated (p<0.05) with a positive perception of health-related quality of life measured by ESI-55, before and after surgical evaluation. CONCLUSION: Our study demonstrated in a homogeneous group of MTLE with HS, a modest, but positive relationship between surgical outcome and work gain, and that QOL had strong correlation with the fact of being employed.
Acesso aberto (Open Access)
Epilepsia do lobo temporal: tratamento cirúrgico
(Academia Brasileira de Neurologia - ABNEURO, 1996-12-01) Rassi Neto, Aziz [UNIFESP]; Campos, Carlos J. Reis de [UNIFESP]; Muszkat, Mauro [UNIFESP]; Ferraz, Fernando P. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopatologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).
Acesso aberto (Open Access)
Fatores prognósticos no tratamento do carcinoma epidermóide da laringe: cirurgia conservadora x radical
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-12-01) Vidal, Maria Da Graça Caminha [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Abrahão, Márcio [UNIFESP]; Hojaij, Flávio Carneiro [UNIFESP]; Amar, Ali [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Santa Maria Hospital SCCP; Universidade de São Paulo (USP); Hospital Heliópolis
The present study aimed at assessing the other sites as the carcinoma spreads, as well as therapeutic results, in larynx preservation and patient survival. STUDY TYPE: It is a Longitudinal Historical Cohort Study, a retrospective clinical study. MATERIALS AND METHODS: A hundred and sixty (160) patients treated at Escola Paulista de Medicina ( Paulista Medical School) - São Paulo Hospital, from January 1988 to December 2004 were examined as for the spreading of their larynx carcinoma. Those patients whose evaluations were at least two years old after treatment were the only ones accepted. The parametric tests used were: Test X2, Fisher s test, and Kaplan-Meier s curve. RESULTS: The posterior commissure and the infraglottis were significant in terms of the laryngectomy: glottal tumors AC: (p=0.03) AP: (p=0.0001); AC: (p=0.0007) AP: (p<0.0001), respectively. The infraglottis was significant in G+SG tumors in AP: (p=0.04) and in death rate AP: (p=0.03). CONCLUSION: total laryngectomy is the treatment of choice in the presence of total involvement of the posterior commissure and the infraglottis. The latter may compromise survival, according to local invasion, even in the presence of free surgical margins.
Acesso aberto (Open Access)
Implementação financeira e o impacto do mutirão de cirurgias de varizes, após a criação do Fundo de Ações Estratégias e Compensação (FAEC)
(Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV), 2011-12-01) Souza, Maira Oliveira; Miranda Júnior, Fausto [UNIFESP]; Poli de Figueiredo, Luiz Francisco [UNIFESP]; Pitta, Guilherme Benjamin Brandão; Aragão, José Aderval [UNIFESP]; Sociedade Brasileira de Angiologia e de Cirurgia Vascular; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); UNCISAL; Universidade Tiradentes Faculdade de Medicina
BACKGROUND: In spite of the fact that the number of surgeries presented by the elective surgery task force did not entirely reflect the reality, it is possible to declare that the financial implementation of the Brazilian Ministry of Health has been significative, as well as the increasing number of varicose vein surgeries, especially after the creation of the Strategic Actions and Compensation Fund (FAEC). OBJECTIVE: To evaluate the application of financial investment in the Ministry of Health campaign for varicose vein surgery. METHODS: A transversal study of retrospective nature has been conducted, using information available at the Data Processing Department of the National Healthcare System database (DATASUS). All the authorization of hospital internment from the inferior member varicose vein surgeries, financed by the Brazilian Ministry of Health from January 1998 to December 2004, have been included in the research. RESULTS: In 1998, before the implementation of the elective surgery task force, 23,531 varicose vein surgeries have been performed, and R$ 5,819,033.27 invested. After the creation of the FAEC, 457,026 inferior member varicose vein surgeries have been performed from 1999 to 2004, and R$ 187,760,196.81 were invested with an average of R$ 31,293,336.13 per year. CONCLUSION: Thus, it is possible to conclude that the bigger investment from the Brazilian Ministry of Health, represented by the implementation of the elective surgery task forces by the FAEC, has been responsible for increasing the number of varicose vein surgeries all around Brazil.
Acesso aberto (Open Access)
Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair
(Academia Brasileira de Neurologia - ABNEURO, 2013-09-01) Faria, Tereza Cristina Carbonari de; Cavalheiro, Sergio [UNIFESP]; Hisaba, Wagner Jou [UNIFESP]; Moron, Antonio Fernandes [UNIFESP]; Torloni, Maria Regina [UNIFESP]; Oliveira, Ana Lucia Batista de; Borges, Carolina Peixoto; Universidade Federal de São Paulo (UNIFESP); Hospital Israelita Albert Einstein
Objective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6) or not (Group B; n=7) were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05). Five children in Group A and one in Group B were community ambulators. Conclusion Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair.
Acesso aberto (Open Access)
Indicação cirúrgica otorrinolaringológica em um ambulatório para pacientes com síndrome da apnéia e hipopnéia obstrutiva do sono
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2004-01-01) Martinho, Fernanda Louise [UNIFESP]; Zonato, Adriane Iurck; Bittencourt, Lia Rita Azeredo [UNIFESP]; Gregório, Carla Lobato; Gregório, Luiz Carlos [UNIFESP]; Tufik, Sergio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Faculdade de Medicina do ABC
AIM: Otolaryngology surgical procedure is an option for obstructive sleep apnea-hypopnea syndrome (OSAHS) treatment. The objective of this study is to show which procedures can be done well as their indications. STUDY DESIGN: Clinical retrospective. METHOD: 223 patients with OSAHS were studied in Otolaryngology Department of UNIFESP. Every patient had a previous polissonography, and they were analyzed and treatment options were proposed. The treatment options were divided in no surgical (CPAP, dental appliance and general measures) and surgical procedures (pharynx surgery, rhinosurgery and maxillofacial surgery). RESULT: 100 patients (44,8%) had surgery indication, and 168 procedures were proposed. The majority uvulopalatopharyngoplasty and radiofrequency of the soft palate were indicated in mild and moderate OSAHS cases and maxillomandibular surgery were indicated in severe cases. Tonsillectomy and rhinosurgery were indicated independently of OSAHS severity. CONCLUSION: The otolaryngological surgery is an option in OSAHS treatment, and your indication depends on OSAHS severity. The surgical procedure can be done whit curative intetion or to avoid CPAP use.
Somente Metadadados
Infecção do trato urinário associada à sonda vesical após cirurgia cardiovascular: impacto de um programa de prevenção
(Universidade Federal de São Paulo (UNIFESP), 2014-10-31) Andrioli, Edivete Regina [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de Medeiros [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: Urinary tract infection (UTI) is one of the most common hospital-acquired infections. Approximately 80% of these infections are associated to an indwelling urinary catheter (CAUTI). Despite the risk of infections and complications due to urinary catheter use to be known, few Brazilian studies have assessed the impact of interventions to reduce the length of stay of catheter, the CAUTI rate and the urinary catheter utilization ratio. Objectives: To assess the impact of a prevention program on CAUTI rate and urinary catheter utilization ratio in the Cardiovascular Surgery Intensive Care Unit at Hospital São Paulo; to evaluate the impact on adherence to recommendations of insertion, management and length of stay of urinary catheter; and to determine CAUTI rate and asymptomatic bacteremic Urinary Tract Infection rate. Methods: Prospective and intervencional study conducted at Hospital São Paulo, Universidade Federal de São Paulo / Escola Paulista de Medicina, from April 1st 2011 to September 30th 2012, and divided into three periods - pre-intervention, intervention and postintervention - with six-month duration each period. In the intervention period was carried out an observation of catheter insertion technique in the operating room, observation of catheter maintenance care in the Cardiovascular Surgery Intensive Care Unit, assessment of necessity of catheter staying, training to correct the mismatches and implement CAUTI prevention measures, evaluation of knowledge before and post training, dissemination of compliance rate and CAUTI rate. In the pre and postintervention periods was monitored CAUTI rate and urinary catheter utilization rate. The CDC/NHSN criteria, 2011, were adopted to identify UTI. In the statistical analysis was adopted a 5% significant level. Results: In the first phase we had 110 patients undergoing to cardiovascular surgery, 102 in the second phase and 118 in the third phase. There was no statistical difference among clinical and demographic variables of patients, length of stay in the ICU and in the hospital, and length of stay of invasive devices, in three phases of study. In the first period occurred six CAUTI, five in the second and two in the third, and no one Asymptomatic Bacteremic Urinary Tract Infection in three periods. The CAUTI rate was 11,42 infections/1000 catheter-days in the first phase, 7,83 in the second and 4,40 in the third, there was a 61,7% reduction, however no significant trend was observed (p=0.216). The urinary catheter utilization rate was 0.62, 0.72 and 0.61, respectively, there was a 1,4% reduction, without a significant tendency (p=0,881). The risk of infection in the pre-intervention phase was 2,60 times major than the postintervention phase (RR 2.60; CI95% 1.35 ? 5.00; p=0.004) and the men had risk of infection 3,80 times major than the women (RR 3.80; CI95% 2.06 ? 7.04; p<0.001). There was an improvement of hand hygiene compliance before bladder catheter insertion (p=0.001) and after (p=0.004), catheter fixation (p=0,001) and all maintenance care together (p=0.036). The assessment of reasons of catheter staying revealed no difference statistical, including when was inappropriate (p=0.247). The knowledge of professionals improved post training (p=0,015). Conclusion: With the program adopted, the CAUTI rate was reduced by 61,7% in the Cardiovascular Surgery Intensive Care Unit at Hospital São Paulo. The urinary catheter utilization ratio was not reduced. There was a meaningful improvement of practice with regard to hand hygiene before and after catheter insertion, catheter fixation and all maintenance care together, and also of knowledge of professionals.
Acesso aberto (Open Access)
Meningeoma da goteira olfatória
(Academia Brasileira de Neurologia - ABNEURO, 2006-03-01) Tella Jr, Osvaldo Inácio de [UNIFESP]; Paiva Neto, Manoel Antonio de [UNIFESP]; Herculano, Marco Antonio; Faedo Neto, Atílio; Universidade Federal de São Paulo (UNIFESP); Hospital Professor Edmundo Vasconcelos; Faculdade de Medicina de Jundiaí
Olfactory groove meningiomas compromise approximately 8-18% of intracranial meningiomas and harbor frequently large sizes when diagnosticated. We report 13 consecutive cases operated on Hospital São Paulo and Hospital Professor Edmundo Vasconcelos between 1995 and 2003. These patients were retrospectively studied regarding clinical preservation, surgical results and complications. The patients underwent uni or bifrontal craniotomies. There were nine complete resections including duramater and infiltrate bone and four patients with tumor removal and duramater coagulation. One patient died on post-operative period due to brain infarction and three patients had cerebrospinal fluid fistula that resolved. There were no symptomatic recurrence on the follow-up period of 3.3 years(range 11 m to 8 years). With current microsurgical techniques, these tumors can be resected safely with low morbidity.
Acesso aberto (Open Access)
Metástases do segmento torácico e lombar da coluna vertebral: estudo prospectivo comparativo entre o tratamento cirúrgico e radioterápico com a imobilização externa e radioterapia
(Academia Brasileira de Neurologia - ABNEURO, 2007-09-01) Falavigna, Asdrubal [UNIFESP]; Righesso Neto, Orlando; Ioppi, Ana Elisa Empinotti; Grasselli, Juliana; Universidade Federal de São Paulo (UNIFESP); Santa Casa de São Paulo Faculdade Federal de Ciências Médicas; UCS
Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patient's decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation longer and significant reduction of pain.
Acesso aberto (Open Access)
Mutirão de cirurgias de adenotonsilectomias: uma solução viável?
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-08-01) Antunes, Marcos Luiz [UNIFESP]; Frazatto, Ricardo [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Vieira, Fernando Mirage Jardim [UNIFESP]; Yonamine, Fernando Kaoru [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); faculdade de medicina do ABC; Hospital Estadual de Diadema
Public hospitals in Brazil are under capacity for adenotonsillectomies, resulting in a growing waiting line. Otolaryngologists are used to these lines, since they understand that this problem is under govern responsibility. For this reason we believe that joint aid efforts to carry out adenotonsillectomies are justified. AIM: To standardize the organization of adenotonsillectomies in joint aid efforts, its effectiveness and feasibility for public hospitals, and to compare the incidence of post-operative hemorrhage in joint aid effort surgery with that of regular surgeriy. METHODS: A clinical case-control prospective study of adenotonsillectomies done in joint aid efforts was done from September 2004 to June 2006 at the Diadema State Hospital. An analysis was made of the multiprofessional staff involved in this process, and a comparison was made of the incidence of hemorrhage in joint aid efforts and after regular surgery. RESULTS: 22 joint aid effort events for adenotonsillectomies were done during the period mentioned above (339 surgeries), an average 15.4 surgeries per event. The rate of postoperative hemorrhage requiring surgical revision was 1.48%(5/339), which did not differ statistically from the case-control group (1.37% - 5/364). CONCLUSION: We were able to standardize the results of adenotonsillectomies done in a joint aid effort to the parameters that are considered as safe. This may reduce the waiting line for this procedure. The difference in the incidence of postoperative hemorrhage in the joint aid effort and regular surgery was not statistically significant.
Acesso aberto (Open Access)
Níveis cardíacos de troponina I em pacientes com epilepsia do lobo temporal refratária após cortico-amígdalo-hipocampectomia
(Liga Brasileira de Epilepsia (LBE), 2007-03-01) Colugnati, Diego Basile [UNIFESP]; Cukiert, Arthur; Matos, Wilna Klecia Lima; Albuquerque, Marly de [UNIFESP]; Arida, Ricardo Mario [UNIFESP]; Cavalheiro, Esper Abrão [UNIFESP]; Cysneiros, Roberta Monterazzo [UNIFESP]; Pansani, Aline Priscila [UNIFESP]; Almeida, Antonio-carlos Guimarães de; Baldauf, Cristine; Argentoni-Baldochi, Meire; Baise-Zung, Carla; Scorza, Fulvio Alexandre [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Mogi das Cruzes Núcleo de Pesquisas Tecnológicas; Hospital Brigadeiro Departamento de Neurologia e Neurocirurgia; Centro Universitário São Camilo; Hospital Israelita Albert Einstein; Universidade Federal de São João del-Rei Departamento de Engenharia Biomédica
PURPOSE: Sudden unexpected death in epilepsy (SUDEP) is the main cause of death in patients with epilepsy. Morphologic and functional changes in the heart are related to SUDEP. The aim of our study was to verify the concentration of troponin I, an important marker of myocardium damage, in patients with temporal lobe epilepsy who were submitted to surgical resection and were not seizure-free after the procedure. METHODS: Eleven non-consecutive patients participated in the study and all of them presented poor seizure control after surgical procedure. Troponin I levels higher then 1 ng/ml indicate myocardium damage. The detection level of the kit used in our study was 0,15 ng/ml. RESULTS: Only three patients showed detectable troponin I levels. The troponin I levels found in our study is not related with sex, age or side of the lesion. CONCLUSIONS: In spite of we did not find positive results in our study, an active role of the heart in SUDEP cannot be discarded, since some injuries, even so not being capable to modify troponin I levels, can be enough to generate arrhythmogenic foci.
Acesso aberto (Open Access)
Osteomas fronto-etmoidais: aspectos clínicos e cirúrgicos
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2002-08-01) Tiago, Romualdo Suzano Louzeiro [UNIFESP]; Melo, Erich Christiano Madruga De; Fobé, Lisete Pessoa De Oliveira; Universidade Federal de São Paulo (UNIFESP); FMO HSPE Serviço de Otorrinolaringologia; Universidade de São Paulo (USP); Hospital São Luiz
Introduction: Fronto-ethmoidal osteomas are the most frequent paranasal sinus benign tumor and they may envolve with either infectious complications and destruction of adjacent structures. Though they are relatively frequent, few of them are cases requiring surgery. Aim: To report on a group of nine patients with frontal or ethmoidal osteoma, as well as to discuss the clinical presentation and the most suitable treatment of this disease. Study design: Clinical prospective. Material and Method: A prospective clinical study of nine patients who were submitted to surgery at the HSPE-FMO (State Public Servants Hospital) of São Paulo, and at the São Luiz Hospital of the city of São Paulo, in the period from 1995 to 1999. The surgical treatment was the therapeutic option selected in this group. The clinical evolution was assessed during the postoperative period. Results: Of the nine patients, five were females and four a male, ages ranging from 12 to 55 years, with an average age of 39,55 years. All the patients had a resolution of the symptoms and only one of them presented sequels (hyposmia). Conclusion: Based on both the literature review and on the cases followed, the authors concluded that the lesions compromising the drainage of the frontal sinus osteos, those with destruction of the sinus limits as well as any ethmoidal tumors should be surgically treated.
Acesso aberto (Open Access)
Padronização das técnicas de secção do nervo facial e de avaliação da mímica facial em ratos
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2006-06-01) Faria, Simone Damasceno De [UNIFESP]; Testa, Jose Ricardo Gurgel [UNIFESP]; Borin, Andrei [UNIFESP]; Toledo, Ronaldo N. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
AIM: standardization of the technique to section the extratemporal facial nerve in rats and creation of a scale to evaluate facial movements in these animals before and after surgery. STUDY DESIGN: Experimental. METHOD: twenty Wistar rats were anesthetized with ketamine xylazine and submitted to sectioning of the facial nerve near its emergence through the mastoid foramen. Eye closure and blinking reflex, vibrissae movement and positioning were observed in all animals and a scale to evaluate these parameters was then created. RESULTS: The facial nerve trunk was found between the tendinous margin of the clavotrapezius muscle and the auricular cartilage. The trunk was proximally sectioned as it exits the mastoid foramen and the stumps were sutured with a 9-0-nylon thread. An evaluation and graduation scale of facial movements, independent for eye and vibrissae, was elaborated, together with a sum of the parameters, as a means to evaluate facial palsy. Absence of eye blinking and closure scored 1; the presence of orbicular muscle contraction, without blinking reflex, scored 2; 50% of eye closure through blinking reflex, scored 3, 75% of closure scored 4. The presence of complete eye closure and blinking reflex scored 5. The absence of movement and posterior position of the vibrissae scored 1; slight shivering and posterior position scored 2; greater shivering and posterior position, scored 3 and normal movement with posterior position, scored 4; symmetrical movement of he vibrissae, with anterior position, scored 5. CONCLUSION: The rat anatomy allows easy access to the extratemporal facial nerve, allowing its sectioning and standardized suture. It was also possible to establish an evaluation and graduation scale of the rat facial movements with facial palsy based on the clinical observation of these animals.
Acesso aberto (Open Access)
Resultados clínicos e satisfação dos pacientes após blefaroplastia inferior
(Colégio Brasileiro de Cirurgiões, 2011-10-01) Viana, Giovanni André Pires [UNIFESP]; Osaki, Midori Hentona [UNIFESP]; Nishi, Mauro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
OBJECTIVE: To evaluate the results of fifty patients undergoing transcutaneous lower eyelid blepharoplasty. METHODS: We conducted a prospective, randomised, controlled trial between April 2005 and May 2007. Patients were randomly divided into two groups: Group 1 consisted of 25 surgical patients undergoing traditional lower blepharoplasty and routine lateral canthopexy; Group 2 consisted of 25 patients undergoing lower blepharoplasty with fat bags transposition and routine lateral canthopexy. We used the Rosenberg Self-Esteem Scale UNIFESP / EPM to assess patients' self-esteem. We also requested the participation of three independent surgeons, who examined the pre and postoperative photographs and quantified the results with the aid of a topographic scale. RESULTS: The mean age was 48.8 years, predominantly females (96%). The analysis of photographs showed a 96% significant improvement. Self-esteem scores improved from a preoperative average of 5.1 (SD = 4.1) to a mean of 3.6 (SD = 3.5) six months after the operation (p = 0.001). CONCLUSION: Both procedures are safe and effective with low complication rates, causing improvement of self-esteem assessed six months after the operation.

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