Validação de técnica hemostática do complexo arteriovenoso ovariano na ovariosalpingohisterectomia de gatas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da lipocalina associada à gelatinase de neutrófilos (NGAL) em idosos após osteossíntese de fêmur

Pós-graduação em Anestesiologia - FMB

Single-port retroperitoneal renal biopsy using standard urological instruments

Objective: To describe the surgical technique and initial experience with a single-port retroperitoneal renal biopsy (SPRRB).Materials and Methods: Between January and April 2013, five children underwent SPRRB in our hospital. A single 1.5 cm incision was performed under the 12th rib at mid-axillary line, and an 11 mm trocar was inserted. A nephroscope was used to identify the kidney and dissect the perirenal fat. After lower pole exposure, a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample.Results: SPRRB was successfully performed in five children. The mean operative time was 32 minutes, and mean estimated blood loss was less than 10 mL. The hospital stay of all patients was two days because they were discharged in the second postoperative day, after remaining at strict bed rest for 24 hours after the procedure. The average number of glomeruli present in the specimen was 31.Conclusion: SPRRB is a simple, safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy.

Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization

Introduction: The frequency of surgical procedures has increased steadily in recent decades, including the myocardial revascularization.Objectives: To demonstrate the importance of physiotherapy in the preoperative period of cardiac surgery in relation to the reduction of hospital stay, changes in lung volumes and respiratory muscle strength.Methods: We conducted a prospective study with patients undergoing myocardial revascularization, the Hospital das Clinicas da Universidade Estadual Paulista (UNESP)/Botucatu - SP. We evaluated 70 patients of both genders, aged between 40 and 75 years, subdivided into two groups: group I - 35 patients of both genders, who received a written protocol guidance, breathing exercises and respiratory muscle training in the preoperative period and group II - 35 patients of both genders, who received only orientation of the ward on the day of surgery. This study was approved by the Ethics Committee of UNESP /Botucatu - SP.Results: Maximal inspiratory pressure in third postoperative day and fifth postoperative day and significant difference between groups, being better for the intervention group. Expiratory pressure was significant in fifth postoperative day in the intervention group compared to controls. The difference of length of hospital stay in the postoperative was found between the groups with shorter hospital stay in the group receiving preoperative therapy.Conclusion: Physical therapy plays an important role in the preoperative period, so that individuals in the intervention group more readily restored the parameters evaluated before surgery, in addition, there was a decrease in the time of the postoperative hospital stay. Thus, it is thought the cost-effectiveness of a program of preoperative physiotherapy.

Associação da catastrofização da dor com a incidência e a intensidade da dor perineal aguda e persistente após parto normal: estudo longitudinal tipo coorte

BACKGROUND AND OBJECTIVES: Vaginal birth delivery may result in acute and persistent perineal pain postpartum. This study evaluated the association between catastrophizing, a phenomenon of poor psychological adjustment to pain leading the individual to magnify the painful experience making it more intense, and the incidence and severity of perineal pain and its relationship to perineal trauma. METHOD: Cohort study conducted with pregnant women in labor. We used the pain catastrophizing scale during hospitalization and assessed the degree of perineal lesion and pain severity in the first 24 hours and after 8 weeks of delivery using a numerical pain scale. RESULTS: We evaluated 55 women, with acute pain reported by 69.1%, moderate/severe pain by 36.3%, and persistent pain by 14.5%. Catastrophizing mean score was 2.15 ± 1.24. Catastrophizing patients showed a 2.90 relative risk (RR) for perineal pain (95% CI: 1.08-7.75) and RR: 1.31 for developing persistent perineal pain (95% CI: 1.05-1.64). They also showed a RR: 2.2 for developing acute and severe perineal pain (95% CI: 1.11-4.33). CONCLUSIONS: The incidence of acute and persistent perineal pain after vaginal delivery is high. Catastrophizing pregnant women are at increased risk for developing acute and persistent perineal pain, as well as severe pain. Perineal trauma increased the risk of persistent perineal pain.

Internal carotid artery pseudoaneurysm after tonsillectomy treated by endovascular approach. A case report

Surgery on the head and neck region may be complicated by vascular trauma, caused by direct injury on the vascular wall. Lesions of the arteries are more dangerous than the venous one. The traumatic lesion may cause laceration of the artery wall, spasm, dissection, arteriovenous fistula, occlusion or pseudoaneurysm. We present a case of a child with a giant ICA pseudoaneurysm after tonsillectomy, manifested by pulsing mass and respiratory distress, which was treated by endovascular approach, occluding the lesion and the proximal artery with Histoacryl. We reinforce that the endovascular approach is the better way to treat most of the traumatic vascular lesions.

Potentiation of epidural lidocaine by co-administering tramadol by either intramuscular or epidural route in cats

This study investigated the analgesic and systemic effects of intramuscular (IM) versus epidural (EP) administration of tramadol as an adjunct to EP injection of lidocaine in cats. Six healthy, domestic, shorthair female cats underwent general anesthesia. A prospective, randomized, crossover trial was then conducted with each cat receiving the following 3 treatments: EP injection of 2% lidocaine [LEP; 3.0 mg/kg body weight (BW)]; EP injection of a combination of lidocaine and 5% tramadol (LTEP; 3.0 and 2.0 mg/kg BW, respectively); or EP injection of lidocaine and IM injection of tramadol (LEPTIM; 3.0 and 2.0 mg/kg BW, respectively). Systemic effects, spread and duration of analgesia, behavior, and motor blockade were determined before treatment and at predetermined intervals afterwards. The duration of analgesia was 120 ± 31 min for LTEP, 71 ± 17 min for LEPTIM, and 53 ± 6 min for LEP (P < 0.05; mean ± SD). The cranial spread of analgesia obtained with LTEP was similar to that with LEP or LEPTIM, extending to dermatomic region T13-L1. Complete motor blockade was similar for the 3 treatments. It was concluded that tramadol produces similar side effects in cats after either EP or IM administration. Our findings indicate that EP and IM tramadol (2 mg/kg BW) with EP lidocaine produce satisfactory analgesia in cats. As an adjunct to lidocaine, EP tramadol provides a longer duration of analgesia than IM administration. The adverse effects produced by EP and IM administration of tramadol were not different. Further studies are needed to determine whether EP administration of tramadol could play a role in managing postoperative pain in cats when co-administered with lidocaine after painful surgical procedures.

Retromolar canal associated with age, side, sex, bifid mandibular canal, and accessory mental foramen in panoramic radiographs of Brazilians

Background. The retromolar canal (RMC) is an anatomical variation that can cause complications in dental procedures. Method. The RMC was evaluated according to age, sex, and presence of accessory mandibular canal and accessory mental foramen, on both sides in 500 panoramic radiographs, belonging to individuals at the age of 7 to 20 years. The associations of interest were studied through Fisher's Exact Test and Pearson's Chi-Square Test, and the correlation was studied through Pearson's Correlation Coefficient (r). The significance level used was 5%. Results. The RMC was observed in 44 radiographs (8.8%), and out of those 24 were females. There was no statistically significant association between the RMC and age (p > 0.05; Fisher's Exact Test), sex (p = 0.787; Pearson's Chi-Square Test), amount of mandibular canals and mental foramina, on both sides (p > 0.05; Pearson's Chi-Square Test). There was a significant association between RMC and side, the higher frequency of the canal being on the right side (p < 0.05; Fisher's Exact Test). Conclusions. Despite the low occurrence of the RMC, its identification and the verification of its dimensions and path are relevant, mainly in cases when anesthetic and surgical procedures can present failures or difficulties.

Conventional versus biological therapy for prevention of postoperative endoscopic recurrence in patients with Crohn's disease: an international, multicenter, and observational study

Postoperative endoscopic recurrence (PER) occurs in nearly 80% of patients 1 year after ileocecal resection in patients with Crohn's disease (CD). Biological agents were more effective in reducing the rates of PER in comparison with conventional therapy, in prospective trials. The aim of this study was to compare the PER rates of biological versus conventional therapy after ileocecal resections in patients with CD in real-world practice. The MULTIPER (Multicenter International Postoperative Endoscopic Recurrence) database is a retrospective analysis of PER rates in CD patients after ileocecal resection, from 7 referral centers in 3 different countries. All consecutive patients who underwent ileocecal resections between 2008 and 2012 and in whom colonoscopies had been performed up to 12 months after surgery, were included. Recurrence was defined as Rutgeerts' score ≥i2. The patients were allocated to either biological or conventional therapy after surgery, and PER rates were compared between the groups. Initially, 231 patients were evaluated, and 63 were excluded. Of the 168 patients in the database, 96 received anti-tumor necrosis factor agents and 72 were treated with conventional therapy after resection. The groups were comparable regarding age, gender, and perianal disease. There was longer disease duration, more previous resections, and more open surgical procedures in patients on biologicals postoperatively. PER was identified in 25/96 (26%) patients on biological therapy and in 24/72 (33.3%) patients on conventional therapy (P=0.310). In this retrospective observational analysis from an international database, no difference was observed between biological and conventional therapy in preventing PER after ileocecal resections in CD patients.

Estudo clínico comparativo da manutenção do aprofundamento de sulco nas vestibuloplastias mandibulares, através das técnicas de tuneilização submucosa e epitelização secundária

For some time, oral surgeons have tried several surgical procedures to improve the alveolar ridge for prosthetic appliance construction. The techniques used for this purpose are divided into four groups: submucosal vestibuloplasty; secondary epithelization; soft tissue grafting and transpositional flaps. Twenty patients who had problems to wear dentures due to unsatisfactory retention and stability were selected at the Oral and MaxilloFacial Surgery and Traumatology Clinic of Dental School of São José dos Campos. They were divided in two groups and operated by submucosal vestibuloplasty using stents and secondary epithelization vestibuloplasty by Clark's technique and were evaluated twelve months after operations in relationship of the sulcus depth. The results were obtained by clinical and radiological examination before and after surgery, and they are similar to those found in the literature reaching satisfactory functional judgement

Supratarsal approach to treatment of zygomatic complex fractures

Many incisions have been described for approaches to zygomatic fractures. Precise repositioning of zygomatic complex fractures is difficult. The traditional approach is through an eyebrow incision, but it can produce a scar that causes aesthetic and psychological problems for the patient. We describe the supratarsal fold approach to expose the frontozygomatic suture and to reduce small displacements of frontal sinus anterior wall; it gives good access and excellent aesthetic results.

Estudo histomorfométrico do processo de cicatrização óssea em defeitos cirúrgicos de camanho crítico em calvárias de ratos preenchidos com polímero de mamona

Objectives: The aim of this study was to evaluate the behavior of the polymer histomorphometrically castor during the healing process of defects of critical size calvarial preparations in rats. Materials and Methods: Twenty animals underwent a surgical procedure that was to be held in the calvaria of each animal a critical defect of 8 mm in diameter with a drill trephine. The rats were divided into two groups according to the following procedures: group C received no treatment and the bone defect site was filled with blood clot, group M, the bone defect was filled with castor oil polymer particles. The animals were sacrificed 180 days after the surgical procedures. After routine laboratory procedures the specimens were subjected to analysis histomorphometric. Results: In groups C the newly formed bone tissue was well developed, with adjacent areas of osteoid matrix rich in osteoblasts, and restricted to the vicinity of the edges of the defect. In animals of group M was observed newly formed lamellar bone tissue restricted to the vicinity of the defect edges and particles of polymer Castor distributed throughout the defect. There was a higher percentage of newly formed bone area was statistically significant in group C compared to animals in group M. Conclusions: Within the limits of this study can conclude that the castor oil polymer is biocompatible and had kept the area during the healing of critical size defects in surgically prepared rat calvariae.

Combinação de técnicas para tratamento cirúrgico de fratura do complexo zigomático-maxilar: relato de caso

The zygomatic-maxillary complex due to its projection framed as one of the areas hardest hit by injuries, as well as the nasal bones. Component important in this context, the zygomatic arch fracture is under the direct action of forces due to its structure fragile, resulting in loss of normal convex curvature. Therefore, it is aimed to report a clinical case of male patient, who had leucoderma zygomatic bone fracture using access transcutaneous and intra-oral fracture reduction body of zygoma and zygomatic arch. In addition to evidence combination of closed and open techniques for solving the case. The technique provided the patient excellent cosmetic and functional results.

Estudo histomorfométrico do processo de cicatrização óssea em defeitos cirúrgicos de tamanho crítico em calvárias de ratos preenchidos com polímero de mamona

Objectives: The aim of this study was to evaluate the behavior of the polymer histomorphometrically castor during the healing process of defects of critical size calvarial preparations in rats. Materials and Methods: Twenty animals underwent a surgical procedure that was to be held in the calvaria of each animal a critical defect of 8 mm in diameter with a drill trephine. The rats were divided into two groups according to the following procedures: group C received no treatment and the bone defect site was filled with blood clot, group M, the bone defect was filled with castor oil polymer particles. The animals were sacrificed 180 days after the surgical procedures. After routine laboratory procedures the specimens were subjected to analysis histomorphometric. Results: In groups C the newly formed bone tissue was well developed, with adjacent areas of osteoid matrix rich in osteoblasts, and restricted to the vicinity of the edges of the defect. In animals of group M was observed newly formed lamellar bone tissue restricted to the vicinity of the defect edges and particles of polymer Castor distributed throughout the defect. There was a higher percentage of newly formed bone area was statistically significant in group C compared to animals in group M. Conclusions: Within the limits of this study can conclude that the castor oil polymer is biocompatible and had kept the area during the healing of critical size defects in surgically prepared rat calvariae

Correção da deficiência transversa da maxila por meio da expansão rápida da maxila cirurgicamente assistida

Fundamentation: The correction of maxillary transverse deficiencies involves orthodontic and surgical procedures that can be performed before or after skeletal maturity. The surgically assisted rapid maxillary expansion (SAR ME) is performed by osteotomies through the lateral walls of the maxilla, zygomatic and canines buttresses, palatal and pterygomaxillary sutures, causing the maxillary disjunction. Followed by activation of the expander to the desired over-expansion in order to correct intercuspal later. Objective: The purpose of this study was to discuss the issues involved in the diagnosis of maxillary atresia, SAR ME indications, as well as surgical technique, through a case study. Methods: The male patient, 19 years old, had severe transverse maxillary deficiency with facial pattern III , Class III , with great lip incompetence. The patient underwent general anesthesia in a hospital environment, the osteotomies was done according to the technique described by Epker and Wolford (1980). Postoperatively, the patient underwent activations daily for 15 days and after 6 months, the orthodontist installed fixed orthodontic appliance to prepare the patient to orthognathic surgery later. Conclusion: The diagnosis by clinical evaluation and models study is essential for the indication of SAR ME and this procedure provides good predictability in the correction of transverse deficiency, with minimal morbidity.