Vocal Cysts: Clinical, Endoscopic, and Surgical Aspects

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

Dacriocistorrinostomia externa em hospital universitário: avaliação dos resultados

OBJETIVO: Conhecer a resposta das obstruções nasolacrimais ao tratamento por dacriocistorrinostomia (DCR) externa em um Hospital Universitário. MÉTODOS: Avaliaram-se retrospectivamente 245 procedimentos cirúrgicos realizados em 220 pacientes. Os indivíduos foram estudados quanto à idade, sexo, queixas, antecedentes, sinais clínicos e complicações intra-operatórias. RESULTADOS: A mediana da idade dos pacientes foi de 45 anos e houve predomínio do sexo feminino (70,00%). As queixas mais freqüentes foram epífora (93,06%) e secreção ocular (58,77%). As complicações intra-operatórias ocorreram em 9,37% dos pacientes, tendo ocorrido sangramento excessivo (5,30%), lesão da mucosa nasal (2,85%) e lesão do saco lacrimal (22,0%). em 15,55% dos pacientes foi realizada nova cirurgia. CONCLUSÃO: A chance de cura com a utilização da DCR externa no serviço foi de 71,43%. Considerou-se a utilização desta técnica cirúrgica uma boa opção para o tratamento das obstruções nasolacrimais, em decorrência do baixo índice de complicações e da chance de sucesso com o tratamento.

Surgical treatment of renal cell carcinoma recurrence at the renal fossa following radical nephrectomy

CONTEXTO: A recorrência local única do carcinoma renal de células claras em seu leito renal após nefrectomia radical é um evento raro. Estima-se que essa situação ocorra em 0,8% a 3,6% do total de procedimentos. Comumente, seu diagnóstico é realizado através de tomografia computadorizada de abdômen ou ultra-som renal usados no acompanhamento desses pacientes. É polêmico qual o melhor tratamento dessa rara condição entre urologistas e oncologistas devido aos poucos relatos em literatura. RELATO DE CASO: Relatamos um caso de recidiva neoplásica única no leito renal após quatro anos e meio da nefrectomia radical por adenocarcinoma de células claras, sem evidência de metástases a distância em outros órgãos. O diagnóstico foi realizado por meio de tomografia abdominal em acompanhamento ambulatorial, observando-se massa retroperitoneal em topografia renal. A massa foi retirada por meio de uma incisão subcostal ampliada, em cirurgia sem intercorrências. O paciente evoluiu bem no pós-operatório. Após um ano e meio do procedimento, foi evidenciada uma metástase no pulmão esquerdo, e seis meses após, outra recorrência metastática na nona costela anterior à direita, mesmo com paciente totalmente assintomático. O tratamento cirúrgico agressivo em recorrência local única é um bom método para controlar essa rara doença. Tomografia computadorizada de abdômen deve ser feita em acompanhamento de carcinoma renal por longos períodos após a nefrectomia radical para o diagnóstico de recorrências tardias e o tratamento deve ser feito como o de uma metástase recorrente única.

Laparoscopic management of iatrogenic lesions

Purpose: To present our series of patients who underwent laparoscopic correction of iatrogenic lesions and a review of the literature.Patients and Methods: We evaluated 23 patients who underwent laparoscopic correction of iatrogenic lesions. Thirteen patients had open surgery, 6 had an endoscopic procedure, and 4 had a laparoscopic approach as the first surgical procedure. Vesicovaginal fistulas (VVF) developed in seven patients after open abdominal hysterectomies, and 1 patient presented with a VVF after ureterolithotripsy. A urethral cutaneous fistula developed in one patient after a laparoscopic resection of endometriosis nodules, and 1 patient presented with a ureterovaginal fistula after a perineoplasty. Three patients presented with encrusted ureteral stents after ureterolithotripsy. Ureteral stenosis developed in seven patients: three after open abdominal surgery, three after ureteroscopy, and one after pyeloplasty. One patient had a ureteral injury during laparoscopic partial nephrectomy, and two patients had bowel injuries after a tension-free vaginal tape procedure and a laparoscopic radical prostatectomy.Results: All patients underwent laparoscopic correction of the iatrogenic injuries. One patient had an early recurrence of a VVF, and one patient had a recurrence of a ureteral stenosis. There was one conversion to open surgery because of technical difficulties and one major bleeding event that necessitated blood transfusion. A lower limb compartmental syndrome developed in one patient.Conclusion: Despite the small number of patients and different types of surgeries performed, laparoscopic management of iatrogenic lesions seems to be feasible and safe in experienced hands. Its precise role in the management of this stressful condition still needs to be determined.

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.

Surgical procedures used for post-traumatic neurogenic bladder in a cat: report case

Um gato de um ano de idade, macho, castrado, sem raça definida, foi encaminhado ao Hospital Veterinário Escola para avaliação de retenção urinária associada à subluxação nas vértebras T12-T13, que foi causada por um acidente automobilístico. Realizou-se a denervação do esfíncter uretral, por transecção dos nervos pudendo e hipogástrico, para permitir o esvaziamento da bexiga, porém três meses após a cirurgia inicial o animal apresentou recorrência da retenção urinária. Esfincterotomia endoscópica uretral foi então realizada, resultando em incontinência urinária por quatro meses.

Rapid Prototyping applied to surgical planning for correcting craniofacial malformations in wild animals. A case study of a brazilian fox

Veterinary surgery for treatment of wild animals is becoming an increasingly demanding task because it involves animals of different anatomy, many of them are already stressed and treatment must be performed to the highest standard in the minimum period of time. Craniofacial alterations may occur for three main reasons: genetic, functional or a combination of both. It is possible to modify the functional cause using intraoral devices like inclined plane. The treatment planning can be made based on virtual 3D models and rapid prototyping. An approximately 9 months old, 3.7 kg male Brazilian fox (Lycalopex vetulus) was referred to the Veterinary Hospital. Physical examination showed malocclusion with a deviation of the mandible to the right side. The virtual 3D model of the head was generated based on CT image data. The 3D models and rapid prototyping opened up new possibilities for the surgical planning and treatment of wild animals.

Two Surgical Approaches to Fracture Malunion Repair

Two birds were presented with malunion fractures. The first was a young toco toucan (Ramphastos toco) with malunion of the tarsometatarsus that was treated by an opening-corrective osteotomy and an acrylic-pin external skeletal fixator (type II) to stabilize the osteotomy. The second bird was m adult southern caracara (Caracara plancus) with radial and ulnar malunion that was treated by closing-wedge osteotomies. Stabilization of the osteotomy sites was accomplished through 1 bone plate fixed cranially on the ulna with 6 cortical screws and an interfragmentary single wire in radius. In both cases, the malunion was corrected, but the manus of the southern caracara was amputated because of carpal joint luxation that induced malposition of the feathers.

Peritonite pós-cobertura em cadela Boxer apresentando síndrome de ovário remanescente (SOR)

The ovarian remnant syndrome (ORS) is defined as the persistence of ovarian activity in surgically spayed females, in which part or the entire ovary remains after the surgical procedure. ORS is characterized as a neo-vascular formation that promotes the organ's functions again, and may occur in cats and dogs. This condition causes the return of all undesirable signs of estrus, like male attraction, vaginal secretion (proestral bleeding), anxiety, pseudocyesis, among other symptoms. The recommended treatment is the surgical removal of the remaining ovary tissue. However, this procedure should be performed at the estrogenic stage of the cycle, when the remaining ovary tissue is enlarged due to the presence of follicles, which facilitates its location. Apparently there are no papers on the consequences of an undesirable breeding. Thus, the objective of this article was to report a case of peritonitis in a bitch with ORS after natural breeding, referred to the Hospital Veterinario da Faculdade de Medicina Veterinaria e Zootecnia da UNESP, campus Botucatu, São Paulo, Brazil.

Comparison between laser therapy and non-surgical therapy for periodontitis in rats treated with dexamethasone

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Repair process of surgical defects filled with autogenous bone grafts in tibiae of diabetic rats

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

Intraoral approach for surgical treatment of Eagle syndrome

Eagle syndrome is symptomatic elongation of the styloid process, or calcification of the stylomandibular ligament. Difficulty with deglutition. phonation. cervical movement. and the sensation of a foreign body in the oropharynx are all symptoms of this syndrome. Its treatment consists of partial removal of the styloid process. leaving it within the range of normality. We describe the technique, report it case, and point Out Sortie of the advantages. such as the simplicity of the procedure, reduced operating time, and lack risks of operative complications. (C) 2008 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Evaluation of subcutaneous and alveolar implantation surgical sites in the study of the biological properties of root-end filling endodontic materials

Objective: The aim of this study was to compare two methodologies used in the evaluation of tissue response to root-end filling materials in rats. Material and Methods: Forty rats were divided into 4 groups: in Groups I and II (control groups), empty polyethylene tubes were implanted in the extraction site and in the subcutaneous tissue, respectively; in Groups III and IV, polyethylene tubes filled with ProRoot MTA were implanted in the extraction site and in the subcutaneous tissue, respectively. The animals were killed 7 and 30 days after tube implantation, and the hemi-maxillas and the capsular subcutaneous tissue, both with the tubes, were removed. Specimens were processed and evaluated histomorphologicaly under light microscopy. The scores obtained were analyzed statistically by the Kruskal-Wallis test (p<0.05). Results: There were no statistically significant differences between the implantation methods (p=0.78033, p=0.72039). It was observed that the 30-day groups presented a more mature healing process due to smaller number of inflammatory cells. Conclusions: The present study showed no differences in tissue responses as far as the implantation site and the studied period were concerned. Alveolar socket implantation methodology represents an interesting method in the study of the biological properties of root-end filling endodontic materials due to the opportunity to evaluate bone tissue response.

Patients' Satisfaction After Surgical Facial Reconstruction or After Rehabilitation With Maxillofacial Prosthesis

The matching of the aesthetic, functional, and psychosocial results of a facial deformity may produce devastating effects in its carriers, especially if the lesion is extensive or the treatment is aggressive. Because of this, the objective of the present article was to evaluate patient's satisfaction rating after surgical facial reconstruction or rehabilitation with oral and maxillofacial prosthesis, by means of reviewing the literature.