148 resultados para resection


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To study cases of foreign bodies (FB) in the tracheobronchial tree investigating the clinical and radiological FB characteristics, complications and endoscopic and surgical intervention. Medical and radiological records review of all FB aspiration cases treated at S (a) over tilde uo Paulo State University Hospital over the last 30 years. One hundred and sixty-four FB cases were analyzed; 57% were male, 84% of these were under 16 years old. The most common clinical manifestations were coughing (68.3%) and choking (54.9%). The most common FBs were seeds (peanut, bean, maize) and also small metal or plastic objects. Radiography was normal in 21.3%, atelectasis was present in 40.9%, hyperinsufflation in 17.1% and the FB was radio-opaque in 20.7%. FB time in the bronchial tree varied from hours to years. The most serious complications, as fibroatelectasis and difficult resolution pneumonia, were caused by the long time that the FB remained in the bronchial tree. FB extraction was by endoscopy in 89% of cases, while 6% required surgical extraction or resection of destroyed part of lung, and 5% spontaneously eliminated the FB. There was no mortality in this series. Coughing and choking were the commonest clinical findings. Most FBs were dried seeds. Complications were due to delays in diagnosis, and most would not have existed if the doctor had given credence to the history. Radiography can be normal as most FBs are radiotransparent. FB extraction was by endoscopy, but a few cases required surgery and others were spontaneously eliminated.

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Background: Persistent air leak after pulmonary resection is a difficult complication for thoracic surgeons to manage. Objectives: To show the results of our experience treating persistent pleuropulmonary air leak with autologous blood and review the literature on this specific method of treatment. Methods: Retrospective study of patients with persistent aerial pleuropulmonary fistula treated with autologous blood. The patient's own blood was collected from a peripheral vein and directly introduced through the pleural drain. An inverted siphon was located in the drainage system to avoid prolonged clamping of the drain. This siphon impeded blood return but not air escape. Results: Between January 2001 and August 2008, 27 patients were treated by the above method. Patient age ranged from 2 to 74 years, and 78% were male. Each procedure used a mean quantity of 92 ml blood. Mean persistent air leak time before pleurodesis was 10.6 days and mean time to fistula resolution after pleurodesis was 1.5 days. Twenty-three (85%) patients had persistent pleuropulmonary air leak closed with the above procedure. Conclusion: Treating persistent pleuropulmonary air leak with autologous blood is promising, but further studies are required to quantify its real effectiveness. Copyright (C) 2009 S. Karger AG, Basel

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This is a case report of a true and dissecting aneurysm of the superior labial artery in a 51-year-old patient without risk factors for vascular pathology. The patient complained of swelling of the upper lip, mostly on the left side. A Doppler ultrasonography was used in the diagnosis. The definitive treatment was surgical resection, and the histopathological analysis confirmed the diagnosis. The progress of the patient was satisfactory, leaving a slight change in sensitivity in the area. This seems to be the first reported case of true and dissecting aneurysm of the superior labial artery in the medical literature.

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Background: Oral Squamous Cell Carcinoma (OSCC) is a major cause of cancer death worldwide, which is mainly due to recurrence leading to treatment failure and patient death. Histological status of surgical margins is a currently available assessment for recurrence risk in OSCC; however histological status does not predict recurrence, even in patients with histologically negative margins. Therefore, molecular analysis of histologically normal resection margins and the corresponding OSCC may aid in identifying a gene signature predictive of recurrence.Methods: We used a meta-analysis of 199 samples (OSCCs and normal oral tissues) from five public microarray datasets, in addition to our microarray analysis of 96 OSCCs and histologically normal margins from 24 patients, to train a gene signature for recurrence. Validation was performed by quantitative real-time PCR using 136 samples from an independent cohort of 30 patients.Results: We identified 138 significantly over-expressed genes (> 2-fold, false discovery rate of 0.01) in OSCC. By penalized likelihood Cox regression, we identified a 4-gene signature with prognostic value for recurrence in our training set. This signature comprised the invasion-related genes MMP1, COL4A1, P4HA2, and THBS2. Overexpression of this 4-gene signature in histologically normal margins was associated with recurrence in our training cohort (p = 0.0003, logrank test) and in our independent validation cohort (p = 0.04, HR = 6.8, logrank test).Conclusion: Gene expression alterations occur in histologically normal margins in OSCC. Over-expression of the 4-gene signature in histologically normal surgical margins was validated and highly predictive of recurrence in an independent patient cohort. Our findings may be applied to develop a molecular test, which would be clinically useful to help predict which patients are at a higher risk of local recurrence.

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Objective: To test whether ascorbic acid supplementation has any cytoprotective effect on a model of secondary biliary cirrhosis in young rats.Methods: We studied 40 Wistar rats weaned at the 21st postnatal day. Each group of 10 was subjected to one of the following four treatments, until 49th postnatal day, when they suffered euthanasia: 1) LC-double ligature and resection of the common bile duct and daily administration of ascorbic acid [100 mg/g of body weight (bw)]; 2) LA-double ligature and resection of the common bile duct and daily administration of aqueous vehicle (1 mL/g bw); 3) SC-sham operation and daily administration of ascorbic acid (100 mg/g bw); 4) SA-double ligature and resection of the common bile duct and daily administration of aqueous vehicle (1 mL/g bw). The rats were weighed daily. on the 27th day after the operation they received an intra-peritoneal injection of 1.5 mg/g bw of sodium pentobarbital, and the pentobarbital sleeping time was measured. Blood was collected for serum alanine aminotransferase and aspartate aminotransferase activity measurements, serum albumin and globulin concentrations, and the liver was assessed for liver water and fat content. Data were submitted to two-way ANOVA and paired comparisons between groups were tested using the SNK method. Significance level was set at 0.05.Results: Ascorbic acid supplementation attenuated the effects of cholestasis: decreased the pentobarbital sleeping time, serum globulin, and the liver fat content.Conclusions: Our results corroborate the hypothesis that ascorbic acid supplementation has a cytoprotective effect in secondary biliary cirrhosis.

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Objective: To develop a new submucous fibroids classification for evaluating the viability and the degree of difficulty and complexity of a hysteroscopic myomectomy.Methods: We have included more four parameters in addition to penetration the fibroid into the myometrium. The extra-parameters were: size of the fibroid, it topography, it extension of the base in relation the wall was set and the wall it was set. The fibroids were classified according to the Classification of the European Society for Gynaecological Endoscopy (ESGE) and to the new classification (STEP-W) in patients who were submitted to hysteroscopic resection of submucous fibroids. The possibility of total resection of the fibroid, the operating time, the fluid deficit and the frequency of any complications were considered. The Fisher test, the Student t test and the analysis of variance test were used in the statistical analyses. It was considered statistically significant when the p-value was less than 0.05 in the two-tailed test.Results: In group which the hysteroscopic surgery was considered complete there was no significant difference between the three ESGE levels (0, 1 and 2). Using the STEP-W, the difference between the numbers of complete surgeries was significant (p < 0.001) for the two levels (groups I and II). The difference between the operating times was significant for the two classifications. In relation to the fluid deficit, only the STEP-W showed significant differences between the levels (p=0.02).Conclusions: It seems to us that the new classification (STEP-W) gives more clues to the difficulties of a hysteroscopic myornectomy than the standard classification (ESGE).

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OBJETIVO: desenvolver uma nova classificação pré-operatória dos miomas submucosos para avaliação da viabilidade e do grau de dificuldade da miomectomia histeroscópica. MÉTODOS: conduzimos um estudo onde quarenta e quatro pacientes foram submetidas a ressecção histeroscópica de 51 miomas submucosos. Foram considerados a possibilidade da ressecção total do mioma, o tempo cirúrgico, o balanço hídrico e a incidência de complicações. Os miomas foram classificados pela classificação da sociedade Européia de Cirurgia Endoscópica (CSECE) e pela Classificação Proposta (CP) pelo nosso grupo, que, além do grau de penetração do mioma no miométrio, adiciona como parâmetros a extensão da base do mioma em relação à parede do útero, o tamanho do nódulo em centímetros e a topografia na cavidade uterina. Para análise estatística foram usados o teste de Fisher, o teste t de Student e a análise de variância. Foi considerado estatisticamente significativo quando o valor de p-valor foi menor que 0,05 no teste bicaudal. RESULTADOS: em 47 miomas a cirurgia histeroscópica foi considerada completa. Não houve diferença significativa entre os três níveis (0, 1 e 2) da CSECE. Pela CP, a diferença quanto ao número de cirurgias completas foi significativa (p=0,001) entre os dois níveis (grupos I e II). A diferença da duração da cirurgia quando se compara as duas classificações foi significativa. em relação ao balanço hídrico, apenas a CP mostrou diferenças entre os níveis (p=0,02). CONCLUSÕES: a CP inclui mais dados sinalizadores das dificuldades da miomectomia histeroscópica do que a CSECE, atualmente em uso. Deve ser enfatizado que o número de miomectomias histeroscópicas usado para essa análise foi modesto, sendo interessante a avaliação do desempenho dessa classificação em séries maiores de casos.

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BACKGROUND: Primary pulmonary choriocarcinoma (PPC) is rare and frequently leads to death.CASES: Two young patients presented with previous molar pregnancy and spontaneous serum human chorionic gonadotropin (hCG) normalization. Patient 1 was referred to our center after partial response to chemotherapy. Pulmonary lobectomy was performed, and hCG rapidly declined. During further chemotherapy, liver metastasis was detected by positron emission tomography. Right hepatectomy was performed, and hCG declined for 28 days, but increased again despite chemotherapy. This patient died from hepatic failure 3 years after diagnosis. Patient 2 presented with persistently high hCG, though the affected organ was not identified. Chemotherapy was unsuccessful. Patient reevaluation showed an isolated pulmonary mass. Pulmonary lobectomy was performed; 2 weeks later, hCG was normal and consolidation with 2 cycles of chemotherapy was administered. The patient has been in remission for 24 months. PPC was confirmed by histo pathology and immunohistochemistry in both cases. Gestational origin of the tumor was confirmed by molecular genetic analysis (polymorphic microsatellite markers).CONCLUSION: The possibility of choriocarcinoma cannot be overlooked in young women with an isolated pulmonary mass. Early diagnosis, prompt chemotherapy, and surgical resection in a specialized center improves the prognosis. (J Reprod Med 2010;55:311-316)

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Objective: Report our experience with trigone ventricular meningiomas and review the surgical approaches to the trigone. Method: From 1989 to 2006, six patients with meningiomas of the trigone of the lateral ventricles underwent microsurgical resection. Their clinical features, image, follow up, and surgical approaches were retrospectively analyzed. Results: Five patients presented with large and one with small volume meningioma. Unspecific symptoms occurred in three patients; intracranial hypertension detected in three patients; homonymous hemianopsy in three; and motor deficit present in one patient. Three patients were operated by transparietal transcortical approach, two by middle temporal gyrus approach, and one by parieto-occipital interhemispheric precuneus approach. Total resection was achieved in all patients without additional deficits. Conclusion: Judicious preoperative plan, adequate knowledge of anatomy, and use of correct microsurgical techniques are fundamental in achieving complete resection of trigone meningioma with low morbidity.

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Objetivo: Avaliar a efetividade e as complicações com a aplicação do 5- fluorouracil (5-FLU) no intra-operatório da cirurgia do pterígio. Método: Foram avaliados 28 olhos de 26 indivíduos quanto ao tipo e tamanho do pterígio, cirurgias prévias e a resposta ao tratamento cirúrgico (no 7º , 21º , 60º e 90º dia de pós-operatório). Logo após a exerese do pterígio, aplicou-se 5-FLU (25 mg/ml) no leito cirúrgico, durante cinco minutos; a seguir, realizou-se a técnica de deslizamento de retalho conjuntival. Resultados: A maioria dos pacientes tinha mais de 50 anos de idade e apresentava pterígio primário (70,0%), grau II (60,7%), do tipo involutivo (60,7%). No pós-operatório observaram-se: isquemia (10,7%), deiscência da conjuntiva (7,1%), ceratite (3,5%), conjuntivite (3,5%) e recidiva da lesão em 1 olho (3,5%).Conclusão: O 5-FLU se mostrou droga segura e efetiva na prevenção das recidivas, podendo ser usado como coadjuvante no tratamento do pterígio para prevenir recidivas.

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FUNDAMENTOS: O carcinoma basocelular (CBC) palpebral é o tumor maligno mais freqüente das pálpebras, sendo possível observar casos em que existe recidiva após a exérese tumoral. OBJETIVO: O objetivo deste estudo foi procurar reconhecer fatores relacionados com a recidiva do CBC palpebral. MÉTODOS: No período de 1998 a 2001 foram detectados, na Faculdade de Medicina de Botucatu/Unesp, 23 pacientes que apresentaram recidiva clínica de CBC palpebral. Foi realizada análise retrospectiva dos pacientes, analisando-se idade, sexo, história de exposição solar, localização do tumor na pálpebra, diagnóstico clínico, diagnóstico histológico, acometimento de bordas cirúrgicas e tempo de seguimento. RESULTADOS: em meio aos 23 pacientes analisados, não houve predominância de sexo, e a média de idade foi de 72,9 anos. Dos tumores localizados exclusivamente na pálpebra inferior, sobretudo no canto interno (74,0%), 34,7% eram do tipo sólido ulcerado, e a maioria (66,6%) apresentava margens cirúrgicas livres, quando da ressecção tumoral. CONCLUSÃO: A maioria das recidivas de CBC palpebral foi de tumores do tipo sólido e localizados no canto interno. Margens cirúrgicas livres não representam garantia de que a lesão não vá recidivar ou surgir de novo.

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INTRODUÇÃO: O gene bcl-2 codifica uma proteína envolvida no processo de controle da apoptose. Inicialmente descrito em linfomas e posteriormente em tecidos epiteliais, sua expressão é freqüentemente encontrada em carcinomas de mama, associada a fatores de prognóstico favorável. Como a punção aspirativa por agulha fina (PAAF) tem sido utilizada como um método confiável na investigação de carcinomas de mama, acessamos a expressão de bcl-2 em material assim obtido e correlacionamos sua positividade com o grau histológico, avaliado em material cirúrgico correspondente, das respectivas pacientes, seguindo a classificação de SBR (Scarff, Bloom e Richardson). OBJETIVOS: Avaliar a expressão de bcl-2 em PAAF e correlacionar com grau histológico. METODOLOGIA: A positividade do bcl-2 foi analisada, por imunocitoquímica, em 118 casos consecutivos de PAAF e correlacionada com grau histológico em material cirúrgico correspondente, segundo classificação de SBR. RESULTADOS: A positividade para bcl-2 foi encontrada em 77 de 118 casos de PAAF (65,25%) e foi inversamente proporcional ao grau histológico (84,37%, p = 0,0022). CONCLUSÃO: A expressão de bcl-2 em PAAF correlaciona-se com fator de bom prognóstico. O índice de positividade encontrado, assim como a correlação inversa com grau histológico, está de acordo com dados publicados previamente. O fácil e rápido manejo do material obtido por PAAF permite a aplicação de técnicas complementares, de maneira confiável, como demonstra este estudo. A positividade do bcl-2 correlacionada com baixo grau histológico, assim como com outros fatores de bom prognóstico, pode, no futuro, proporcionar informação preditiva e prognóstica para pacientes candidatas a tratamento quimioterápico neo-adjuvante.

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Os autores descrevem a adaptação da técnica de ligadura e ressecção do ducto biliar comum descrita na literatura, enfatizando suas vantagens na recuperação pós-cirúrgica. Este trabalho foi realizado no Laboratório Experimental do Departamento de Pediatria da FMB-UNESP.

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OBJETIVO: Testar o efeito hepatoprotetor do extrato aquoso de Bidens pilosa L. (EBP) na doença hepática induzida pela ligadura e ressecção do ducto biliar comum (LRDBC) em ratos jovens. MÉTODOS: Estudamos ratos Wistar com 21º. dia de vida (P21) divididos em quatro grupos de 10 animais, Grupo SA: operação simulada e água; Grupo SD: operação simulada e EBP (160mg de folhas frescas/100g de peso corporal/dia); Grupo LA: LRDBC e água e Grupo LD: LRDBC e EBP diariamente. O tempo de sono por pentobarbital (TSP), aspartato (AST) e alanina (ALT) aminotransferase foram determinadas após o sacrifício (P70). O Score de Ruwart (SR) para fibrose hepática foi atribuído para cada animal. Foi realizada análise de variância com dois fatores e pelo teste de Tukey para comparações múltiplas ou por teste não paramétrico. RESULTADOS: Houve diferença estatisticamente significativa entre LA e LD nas variáveis: TSP (médias LA=390; LD=173), AST (médias LA=8, LD=5), ALT (medianas LA=2; LD=1) e SR (medianas LA=2; LD=1). CONCLUSÃO: EBP poderá ser empregado na fitoterapia da doença hepática induzida pela colestase obstrutiva crônica, pois protege a função hepática, diminui a velocidade de necrose e a intensidade da fibrose hepática na obstrução biliar extra-hepática.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)