O uso da endoscopia para o rastreamento do câncer do trato aerodigestório alto em população de alto risco

Pós-graduação em Bases Gerais da Cirurgia - FMB

O uso da endoscopia para o rastreamento do câncer do trato aerodigestório alto em população de alto risco

Pós-graduação em Bases Gerais da Cirurgia - FMB

Simulador virtual de técnicas de endoscopia rígida para formación sanitaria

[ES] En este proyecto se trata el proceso de análisis y desarrollo llevado a cabo con el objetivo de construir un prototipo funcional de simulador virtual de endoscopia rígida monocanal orientado a la histeroscopia. Para el desarrollo del prototipo se toma como base el entorno ESQUI, un entorno de simulación virtual médica de código libre. Este entorno provee una librería, basada a su vez en la conocida librería gráfica VTK(Visual ToolKit), cuyo propósito es poner a disposición del programador toda la algoritmia necesaria para construir una simulación médica virtual. En este proyecto, esta librería se depuró y amplió para mejorar el soporte a las técnicas de endoscopia rígida que se persiguen simular. Por otro lado se emplea el Simball 4D, un dispositivo de interfaz humana de la empresa G-coder Systems, para capturar la interacción del usuario emulando la morfología y dinámica de un endoscopio rígido. Todos estos elementos se conectan con una interfaz gráfica sencilla, intuitiva y práctica soportada por wxWidgets y utilizando Python como lenguaje de scripting. Finalmente, se analiza el prototipo resultante y se proponen una serie de líneas futuras de cara a la aplicación didáctica del mismo, tanto en relación a los objetivos conceptuales del prototipo como a los aspectos específicos del entorno ESQUI.

Sistemi informativi per l'endoscopia digestiva: analisi delle esigenze e progetto di integrazione informativa

Nella tesi, dopo un'introduzione di carattere generale sull'endoscopia digestiva, vengono analizzate le innovazioni tecnologiche che permettono il miglioramento ed il potenziamento delle immagini endoscopiche tramite elaborazione real-time, al fine di rilevare le lesioni non visibili con la luce bianca. L'elaborato analizza il flusso di lavoro del reparto, preso in carico dal sistema informativo di endoscopia. Lo scambio di informazioni tra i diversi sistemi informativi deve avvenire utilizzando gli standard HL7 e DICOM, secondo le specifiche dettate dai profili di integrazione IHE. Nella parte finale del trattato è descritta l'architettura del sistema informativo di endoscopia e sono esposte le specifiche di integrazione informativa.

De la cápsula comunitaria al espacio compartido. La búsqueda del post-espacio público en la vivienda de ACM = From community capsules to shared intervals. The search of the post-public space In the housing developments by ACM

Arquitectos y no arquitectos como Rossi, Grassi, Jacobs, Sennett o Lefebvre, denunciaron críticamente durante los 50, 50 y 70 la ruptura entre la calle y el espacio doméstico y el consiguiente declive del dominio público urbano a escala de ciudad y a escala de barrio. La crítica a la "Ville Contemporaine" no solo se escribía, también se dibujaba y a veces, incluso, se construía. La primera generación post-CIAM trabajó intensamente en desmentir con palabras y obras al Oud que ya en los años 20 del pasado siglo, tomando la delantera a Le Corbusier y desde su mejor sentido práctico y estético afirmaba: "Las calles para el negocio, los patios interiores para la vida. Los dos estrictamente separados y con un carácter contradictorio".

Rendimiento y precisión diagnóstica de la punción-aspiración con aguja fina guiada por endoscopia en lesiones sólidas del tracto digestivo superior

Programa de doctorado: Avances en Medicina Interna. Bienio 2007-2009. La fecha de publicación es la fecha de lectura

Hallazgos ecográficos en la estenosis uretral y su correlación con endoscopia y uretrografía

"Con la implementación estandarizada de la ecografía uretral se pretende tener un efecto directo en el diagnóstico oportuno, no invasivo y sin complicaciones inherentes a la instrumentación del tracto urinario bajo en los pacientes que padecen de estenosis uretral; que finalmente redundará en disminución de costos a corto y largo plazo gracias a la eliminación de estudios innecesarios y procedimientos terapéuticos infructuosos, beneficiando al paciente y al sistema de salud vigente en nuestro medio. Los sujetos con estenosis uretrales complejas podrían ser diagnosticados de manera rápida, sencilla y minimamente invasiva sin importar la localización de la anomalía y su complejidad". (Extracto de la introducción)

Instruções para diluição do Oseltamivir (Tamiflu) a partir da cápsula de 75 mg para administração a crianças [manejo clínico da influenza]

Vídeo do curso de atualização do manejo clínico da influenza, orienta a forma correta de diluição do antivial Oseltamivir (Tamiflu), a partir de cápsulas de 75 mg, para adminstração oral, a crianças.

Instruções para diluição do Oseltamivir (Tamiflu) a partir de cápsula de 75 mg para administração a crianças [cartaz]

O cartaz orienta os pais dos pacientes infantis atendidos na rede da saúde básica, como diluir corretamente o Oseltamivir (Tamiflu) a partir de cápsula de 75 mg para administração a crianças.

Plastias de estenoses de intestino delgado na doença de Crohn: resultados imediatos e tardios

BACKGROUND: Strictureplasty is an alternative surgical procedure for Crohn?s disease, particulary in patients with previous resections or many intestinal stenosis. AIM: To analyze surgical complications and clinical follow-up in patients submitted to strictureplasty secondary to Crohn?s disease. METHODS: Twenty-eight patients (57.1% male, mean age 33.3 years, range 16-54 years) with Crohn?s disease and intestinal stenosis (small bowel, ileocecal region and ileocolic anastomosis) were submitted to strictureplasty, at one institution, between September 1991 and May 2004. Thirteen patients had previous intestinal resections. The mean follow-up was 58.1 months. A total of 116 strictureplasties were done (94 Heineke-Mikulicz - 81%, 15 Finney - 13%, seven side-to-side ileocolic strictureplasty - 6%). Three patients were submitted to strictureplasty at two different surgical procedures and two in three procedures. RESULTS: Regarding to strictureplasty, postoperative complication rate was 25% and mortality was 3.6%. Early local complication rate was 57.1%, with three suture leaks (10.7%) and late complication was present in two patients, both with incisional hernial and enterocutaneous fistulas (28.6%). Patients remained hospitalized during a medium time of 12.4 days. Clinical and surgical recurrence rates were 63% and 41%, respectively. Among the patients submitted to another surgery, two patients had two more operations and one had three. Recurrence rate at strictureplasty site was observed in 3.5%, being Finney technique the commonest one. Presently, 19 patients had been asymptomatic with the majority of them under medical therapy. CONCLUSION: Strictureplasties have low complication rates, in spite of having been done at compromised site, with long term pain relief. Considering the clinical course of Crohn?s disease, with many patients being submitted to intestinal resections, strictureplasties should be considered as an effective surgical treatment to spare long intestinal resections.

Complicações imediatas e tardias após cirurgia de reservatório ileal na polipose adenomatosa familiar

BACKGROUND: Restorative proctocolectomy is the procedure of choice to treat familial adenomatous polyposis, however it can be associated to short-term and long-term postoperative complications. AIM: To evaluate the occurrence of complications related to the surgical treatment of familial adenomatous polyposis with ileal pouch technique. METHODS: Retrospective study of 69 patients with familial adenomatous polyposis after rectocolectomy with ileal reservoir between 1984 and 2006, operated on Coloproctology Group, Medical Sciences Faculty, State University of Campinas, Campinas, SP, Brazil. The median follow-up period was 82 (2-280) months. Data obtained were surgical techniques and postoperative complications. RESULTS: The morbidity and mortality were 63.8% and 2.9%, respectively. The most frequent complications were small-bowel obstruction (17.4%), anastomotic stricture (15.9%) and pelvic sepsis (10.1%). Acute ischemia of the ileal pouch (4.3%), pouchitis (2.9%) and ileal pouch-related fistula (2.9%) had poorer frequency than others. CONCLUSIONS: The morbid-mortality was similar to the literature?s data and it is acceptable for a complex surgery in two terms like the ileal reservoir-anal anastomosis. The small-bowel obstruction was the most frequent complication. However, ischemia of the reservoir, pouchitis and pelvic sepsis were important complications and was related to the failure of the ileal reservoir.

Resultados da cirurgia de reservatórios ileais em pacientes com doença de Crohn

BACKGROUND: Total rectocolectomy and ileal pouch-anal anastomosis is the choice surgical procedure for patients with ulcerative colitis. In cases of Crohn's disease post-operative diagnosis, it can be followed by pouch failure. AIM: To evaluate ileal pouch-anal anastomosis long-term outcome in patients with Crohn's disease. METHODS: Between February 1983 and March 2007, 151 patients were submitted to ileal pouch-anal anastomosis by Campinas State University Colorectal Unit, Campinas, SP, Brazil, 76 had pre-operative ulcerative colitis diagnosis and 11 had post-operative Crohn's disease diagnosis. Crohn's disease diagnosis was made by histopathological biopsies in nine cases, being one in surgical specimen, two cases in rectal stump, small bowel in two cases, ileal pouch in three and in perianal abscess in one of them. The median age was 30.6 years and eight (72.7%) were female. RESULTS: All patients had previous ulcerative colitis diagnosis and in five cases emergency colectomy was done by toxic megacolon. The mean time until of Crohn's disease diagnosis was 30.6 (6-80) months after ileal pouch-anal anastomosis. Ileostomy closure was possible in 10 cases except in one that had ileal pouch fistula, perianal disease and small bowel involvement. In the long-term follow-up, three patients had perineal fistulas and one had also a pouch-vaginal fistula. All of them were submitted to a new ileostomy and one had the pouch excised. Another patient presented pouch-vaginal fistula which was successfully treated by mucosal flap. Three patients had small bowel involvement and three others, pouch involvement. All improved with medical treatment. Presently, the mean follow-up is 76.5 months and all patients are in clinical remission, and four have fecal diversion. The remaining patients have good functional results with 6-10 bowel movements/day. CONCLUSION: Crohn's disease diagnosis after ileal pouch-anal anastomosis for ulcerative colitis may be usual and later complications such fistulas and stenosis are common. However, when left in situ ileal pouch is associated with good function.

Aplicação do escore MELD em pacientes submetidos a transplante de fígado: análise retrospectiva da sobrevida e dos fatores preditivos a curto e longo prazo

BACKGROUND: The model for end-stage liver disease (MELD) was developed to predict short-term mortality in patients with cirrhosis. There are few reports studying the correlation between MELD and long-term posttransplantation survival. AIM: To assess the value of pretransplant MELD in the prediction of posttransplant survival. METHODS: The adult patients (age >18 years) who underwent liver transplantation were examined in a retrospective longitudinal cohort of patients, through the prospective data base. We excluded acute liver failure, retransplantation and reduced or split-livers. The liver donors were evaluated according to: age, sex, weight, creatinine, bilirubin, sodium, aspartate aminotransferase, personal antecedents, brain death cause, steatosis, expanded criteria donor number and index donor risk. The recipients' data were: sex, age, weight, chronic hepatic disease, Child-Turcotte-Pugh points, pretransplant and initial MELD score, pretransplant creatinine clearance, sodium, cold and warm ischemia times, hospital length of stay, blood requirements, and alanine aminotransferase (ALT >1,000 UI/L = liver dysfunction). The Kaplan-Meier method with the log-rank test was used for the univariable analyses of posttransplant patient survival. For the multivariable analyses the Cox proportional hazard regression method with the stepwise procedure was used with stratifying sodium and MELD as variables. ROC curve was used to define area under the curve for MELD and Child-Turcotte-Pugh. RESULTS: A total of 232 patients with 10 years follow up were available. The MELD cutoff was 20 and Child-Turcotte-Pugh cutoff was 11.5. For MELD score > 20, the risk factors for death were: red cell requirements, liver dysfunction and donor's sodium. For the patients with hyponatremia the risk factors were: negative delta-MELD score, red cell requirements, liver dysfunction and donor's sodium. The regression univariated analyses came up with the following risk factors for death: score MELD > 25, blood requirements, recipient creatinine clearance pretransplant and age donor >50. After stepwise analyses, only red cell requirement was predictive. Patients with MELD score < 25 had a 68.86%, 50,44% and 41,50% chance for 1, 5 and 10-year survival and > 25 were 39.13%, 29.81% and 22.36% respectively. Patients without hyponatremia were 65.16%, 50.28% and 41,98% and with hyponatremia 44.44%, 34.28% and 28.57% respectively. Patients with IDR > 1.7 showed 53.7%, 27.71% and 13.85% and index donor risk <1.7 was 63.62%, 51.4% and 44.08%, respectively. Age donor > 50 years showed 38.4%, 26.21% and 13.1% and age donor <50 years showed 65.58%, 26.21% and 13.1%. Association with delta-MELD score did not show any significant difference. Expanded criteria donors were associated with primary non-function and severe liver dysfunction. Predictive factors for death were blood requirements, hyponatremia, liver dysfunction and donor's sodium. CONCLUSION: In conclusion MELD over 25, recipient's hyponatremia, blood requirements, donor's sodium were associated with poor survival.