Lesão por esmagamento do nervo isquiático de ratos: estudo da vascularização

Este trabalho teve como objetivo estudar as alterações microvasculares intraneurais aguda em nervo isquiático de rato submetido a esmagamento por diferentes cargas. Foram utilizados 60 ratos machos da linhagem Wistar, distribuídos em grupos experimentais de acordo com a injeção de vasos e com a carga de esmagamento. Os nervos isquiáticos direitos foram isolados e submetidos ao esmagamento com cargas (0,5 Kg, 1 Kg, 5 Kg, 10 kg e 15 kg) por 10 minutos e os nervos isquiáticos esquerdos foram utilizados como controle. Após esmagamento, os animais foram submetidos à cateterização da aorta abdominal e injeção dos vasos, em seguida 30 nervos direitos e esquerdos foram fixados em formol 10%, desidratados e diafanizados para análise longitudinal dos vasos intraneurais e os restantes retirados em toda a sua extensão, cortados em 3 fragmentos, congelados em isopentano em gelo seco e armazenados em freezer -70°C, seccionados transversalmente para análise e contagem dos vasos intraneurais. As análises macroscópica e microscópica mostraram regiões de hematoma endoneural e epineural nas diferentes cargas de esmagamento. A análise morfométrica sugere que a lesão aos vasos intraneurais foi proporcional à carga de esmagamento, causando hematoma endoneural e epineural, que cria microambiente desfavorável para a regeneração das fibras nervosas.

Complicações neurológicas determinadas pela anestesia subaracnóidea

JUSTIFICATIVA E OBJETIVOS: Complicações neurológicas da anestesia subaracnóidea, apesar de raras, podem determinar seqüelas importantes. O objetivo deste estudo é apresentar estas complicações com a finalidade de esclarecer os fatores desencadeantes, o que facilita o diagnóstico das lesões. CONTEÚDO: São apresentadas as seguintes complicações: lesão de nervo desencadeada pela agulha e cateter, cefaléia pós-punção, síndrome da artéria espinhal anterior, hematoma espinhal, meningite bacteriana, meningite asséptica, aracnoidite adesiva, síndrome da cauda eqüina e sintomas neurológicos transitórios. CONCLUSÕES: O conhecimento dos fatores desencadeantes de complicações neurológicas determinadas pela anestesia subaracnóidea pode prevenir as lesões, diagnosticar e tratar mais precocemente e, desse modo, mudar o prognóstico das mesmas.

Acesso vascular para hemodiálise com cateter temporário de duplo lúmen em cães com insuficiência renal aguda

A hemodiálise é uma modalidade terapêutica que pode sustentar a vida do paciente com insuficiência renal aguda (IRA), enquanto este recupera a função renal. Para sua realização, é necessário estabelecer circulação extracorpórea, para que seja realizada a filtração do sangue, impondo a necessidade de um acesso vascular viável e eficiente. O objetivo deste estudo foi avaliar a eficiência e as complicações do acesso vascular para hemodiálise (HD), com cateter temporário de duplo lúmen inserido na veia jugular externa. Foram estudados 10 cães com IRA induzida por gentamicina, submetidos a sessões diárias de HD, com duração de uma hora, até a recuperação da função renal ou óbito. Foram realizadas 104 sessões de HD nos animais estudados, observando-se necessidade de troca do cateter em sete sessões (6,7%), devido à obstrução do lúmen do cateter em seis sessões (5,8%) ou por saída acidental do mesmo em uma sessão (1,0%). Não se observou migração do cateter, infecção, hemorragia ou hematoma no local de entrada do cateter na pele, obtendo-se fluxo sanguíneo patente em 90,4% das sessões. Concluiu-se que o acesso vascular na veia jugular externa com cateter temporário de duplo-lúmen mostrou-se viável, com ocorrência de poucas complicações, sendo, portanto, indicado como forma de acesso para a circulação extracorpórea para HD em cães com IRA.

Traumatic surdural hygroma - Five cases with changed density and spontaneous resolution

Thirty-four consecutive adult patients with subdural traumatic hygroma were analysed for clinical evolution, serial computed tomography scan (CT), and magnetic resonance imaging (MRI) over a period of several months. Five of the patients presented CT scan and MRI evolution data showing increasing density over a period of 11 days to 6 months post trauma. In these five patients, final clinical and CT scan data were benign, with complete spontaneous resolution. Descriptions in literature of evolving traumatic subdural hygroma have presented CT scan density modifications changing into chronic subdural hematoma. Our patients show another possibility, density transformation, which sometimes show as subdural hematoma in CT scan and MRI, but with final evolution where clinical condition and CT scan return to normal.

Retroperitoneoscopic renal biopsy in children

OBJECTIVE: We present our experience in a series of 17 consecutive pediatric patients submitted to retroperitoneal laparoscopic renal biopsy. MATERIALS and METHODS: Retroperitoneal laparoscopic renal biopsy (LRB) was performed in 5 boys and 12 girls. Mean age was 8.1 years and age range from 2 to 12. Two or three trocars were used to expose the inferior pole of the kidney, remove enough cortical parenchymal specimen and fulgurate the biopsy site. Assessment included surgical time, estimated blood loss, hospitalization period, analgesia requirements, complications and number of glomeruli present in the specimen. RESULTS: LRB was successfully performed in all 15 patients (88%). In two cases, LRB was not possible to be performed. One patient was converted to a transperitoneal laparoscopy due to tear in the peritoneum. The other patient had had previous abdominal surgery and, during retroperitoneal balloon dilation, the peritoneum was opened and the open biopsy was performed. A third patient had postoperatively a perirenal hematoma, which was solved spontaneously. Complication rate was 17.6% (3/17 cases). Mean operative time was 65 minutes, while mean estimated blood loss was 52 mL, mean hospital stay was 2.2 days and mean analgesic requirement was 100 mg of tramadol. The mean number of glomeruli present in the specimen was 60. CONCLUSION: Retroperitoneal laparoscopic renal biopsy in children is a simple, safe. Bleeding is still the most common complication. However, direct vision usually allows a safe control of this drawback. In our institution, laparoscopic approach is the chosen procedure in pediatric patients older than one - year - old.

Clinical evaluation of the bicoronal flap in the treatment of facial fractures. Retrospective study of 132 patients

The aim of the present study was to evaluate the postoperative complications of bicoronal flaps used to treat facial fractures. One hundred and thirty two patients that received bicoronal flaps for the treatment of upper and middle third facial fractures were called for clinical and radiographic examination. Minimum follow-up was 1 year and all patients had charts with adequate information about their perioperative care pertinent to the study. Results showed as complications hypoesthesia (17%), partial unilateral frontal motor deficit (11%), infection (3%), hypertrophic scars (3%), varying degrees of alopecia (18%), seroma or hematoma in the immediate postoperative period (5%). The flap provided wide surgical access to the upper and middle facial thirds with very few serious complications, most frequently allowing good aesthetic results. (C) 2011 European Association for Cranio-Maxillo-Facial Surgery.

Effect of a single acupuncture treatment on surgical wound healing in dogs: a randomized, single blinded, controlled pilot study

Background: The aim of the study was to investigate the effect of acupuncture on wound healing after soft tissue or orthopaedic surgery in dogs.Methods: 29 dogs were submitted to soft tissue and/or orthopaedic surgeries. Five dogs had two surgical wounds each, so there were totally 34 wounds in the study. All owners received instructions for post operative care as well as antibiotic and pain treatment. The dogs were randomly assigned to treatment or control groups. Treated dogs received one dry needle acupuncture treatment right after surgery and the control group received no such treatment. A veterinary surgeon that was blinded to the treatment, evaluated the wounds at three and seven days after surgery in regard to oedema (scale 0-3), scabs (yes/no), exudate (yes/no), hematoma (yes/no), dermatitis (yes/no), and aspect of the wound (dry/humid).Results: There was no significant difference between the treatment and control groups in the variables evaluated three and seven days after surgery. However, oedema reduced significantly in the group treated with acupuncture at seven days compared to three days after surgery, possibly due the fact that there was more oedema in the treatment group at day three (although this difference was nor significant between groups).Conclusions: The use of a single acupuncture treatment right after surgery in dogs did not appear to have any beneficial effects in surgical wound healing.

Long-term outcome of penile fracture treatment

Objectives: Penile fracture is a rare injury, usually resulting from direct trauma to the erect penis during sexual intercourse. Our goal was to evaluate the best diagnostic methods and the late complications following surgical treatment of penile fracture. Material and Methods: We studied retrospectively 11 patients with penile fracture in a period of 10 years (1985-1995). Results: In 55% of the cases, the injury occurred during sexual intercourse. All patients presented with a very suggestive clinical picture (pain, detumescence and hematoma) and only 2 were submitted to further investigation (ultrasonography) to confirm the diagnosis. Only one patient had urethral bleeding and therefore was submitted to retrograde urethrogram, which confirmed urethral injury. All patients were treated by immediate surgery, through a circular subcoronal incision and degloving of the penis to allow a thorough exploration. All patients had a tunica albuginea tear that was promptly repaired, and 2 patients (18%) had associated urethral injury (one had no symptoms) that was also repaired. All patients did very well after surgery and only one had a mild curvature, which did not hinder intercourse during follow-up (18 months). Conclusions: Penile fracture has very typical clinical signs and, therefore, further investigation is usually unnecessary. Early surgical treatment is associated with a low incidence of late complications.

Laryngeal electromyography: Technical features

Laryngeal Electromyography (LEMG) is an auxiliary diagnostic method used for the comprehension and diagnosis of different neurological diseases that compromise laryngeal function. The most common LEMG technique is the percutaneous insertion of needle electrodes guided by surface anatomical references. We describe techniques for inserting needle electrodes into the tireoaritenoideus (TA), cricotireoideus (CT), cricoaritenoideus lateralis (CAL) and cricoaritenoideus posterioris (CAP) muscles; these are used at UNICAMP laryngology ambulatory; we discuss difficulties found and their proposed solutions. All patients were submitted to otorhinolaryngological, phonoaudiological and laryngeal endoscopy before LEMG. The CAP approach, by digital rotation of the thyroid cartilage was found to be the most difficult, followed by the CAL approach. TA and CT approaches gave no major problems, except with some older and obese patients. A significant complication of the TA approach via thyroid cartilage was a hematoma in one patient which partially obstructed the laryngeal lumen.

Naso-orbicular tissue necrosis by Streptococcus parasanguis in a patient with Fanconi anemia: Clinical and laboratory aspects

Fanconi anemia (FA) is a rare autosomal recessive disorder, characterized by pancytopenia and progressive hypoplasia of the bone marrow. A 23-year-old woman with FA showed severe pancytopenia and developed an abscess on the infraorbicular region on the right side of the face that progressed to phlegmon and caused tissue necrosis of the nostrils, nasal septum, nasal fossa, and posterior orbital region. Laboratory examination showed Streptococcus parasanguis as the etiologic agent of the phlegmon. Supportive treatment was recommended due to donor incompatibility for bone marrow transplant. The intraoral examination showed spontaneous gingival bleeding, edema of the interdental papillae, hematomas on the superior and inferior lips, bacterial and fungal infections, and adequate oral hygiene. The patient was treated with the administration of an antibiotic (imipenem), an antifungal (amphotericin B), and mouth washing with antiseptic solutions. Periodontal prophylaxis and orientation to and control of oral hygiene and diet were also used during the remission period. For functional and esthetic rehabilitation of the alar regions and nasal dorsum, an acrylic resin nasal prosthesis was made, supported by a spectacle frame.

Review of the efficacy and safety of cryoablation for the treatment of small renal masses

Purpose: Small renal masses are increasingly being discovered incidentally on imaging for another reason. The standard of care of these masses involves excision by open or laparoscopic techniques. Recently, ablative techniques, such as radiofrequency ablation (RFA) and cryoablation, have taken a more prominent role in the treatment algorithm of these masses. We evaluate the effectiveness and safety of cryoablation to treat renal tumours. Methods: A review of the literature was conducted. There was no language restriction. Studies were obtained from the following sources: the Cochrane Library, PUBMED, EMBASE and LILACS. Results: There was no clinical trial identified in the literature. Thus, we described the results from 23 case series and retrospective studies with a reasonable sample size (number of reported patients in each study ≥30), with a total of 2104 analyzed tumours from 2038 patients. There was wide variability in the outcomes reported, but success rates were generally good. Follow-up was generally short, but some series reported outcomes at 5 years. The most common complications reported were hemorrhage (some of the patients requiring transfusion), perinephric hematoma and urine leaks. Conclusion: Cryoablation presents a feasible treatment for patients with small renal masses. Only short-term data are available and, as such, meaningful conclusions regarding long-term cancer control cannot be made. More rigorous studies are needed. © 2013 Canadian Urological Association.