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BACKGROUND: Bariatric surgery is the best treatment option for patients with obesity. As a result of the advancement of technology, the robotic gastric bypass presents promising results, despite its still high costs. AIMS: The aim of this study was to compare patients submitted to a robotic versus a laparoscopic gastric bypass at a single center by a single surgeon. METHODS: This retrospective study collected data from the medical records of 221 patients (121 laparoscopic procedures versus 100 with daVinci platform). The variables analyzed were sex, age, body mass index, comorbidities, surgical time, length of stay, and complications. RESULTS: The mean surgical time for patients in the robotic group was shorter (102.41±39.44 min versus 113.86±39.03 min, p=0.018). The length of hospital stay in robotic patients was shorter (34.12±20.59 h versus 34.93±11.74 h, p=0.007). There were no serious complications. CONCLUSIONS: The group submitted to the robotic method had a shorter surgical time and a shorter hospital stay. No difference was found regarding strictures, bleeding, or leakage.

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INTRODUCTION: This study aimed to investigate the relationship between bone density and quantity at the insertion sites of palatal miniscrews and skeletal maturation-evaluated with the middle phalanx maturation method-in growing patients. METHODS: Sixty patients were analyzed as having a staged third finger middle phalanx radiograph and a cone-beam computed tomography of the maxilla. On the cone-beam computed tomography, a grid was designed to parallel the midpalatal suture (MPS) and posterior to the nasopalatine foramen, both on the palatal and lower nasal cortical bones. Bone density and thickness were measured at the intersections, and medullary bone density was also calculated. RESULTS: Of patients in MPS stages 1-3, 67.6% showed a mean palatal cortical thickness of <1 mm, whereas in 78.3% of the patients in stages 4 and 5, it was >1 mm. The nasal cortical thickness showed a similar trend (MPS stages 1-3: 62.16% <1 mm; MPS stages 4 and 5: 65.2% >1 mm). There was a significant difference in the density of the palatal cortical bone between MPS stages 1-3 (1272.05 ± 191.13) and stages 4 and 5 (1572.33 ± 274.89) and in nasal cortical density between MPS stages 1-3 (1428.09 ± 198.97) and stages 4 and 5 (1597.97 ± 267.75) (P <0.001). CONCLUSIONS: This study revealed a correlation between skeletal maturity and maxillary bone quality. MPS stages 1-3 have lower palatal cortical bone density and thickness but high nasal cortical bone density values. MPS stage 4 and, even more, stage 5 show increasing palatal cortical bone thickness and palatal and nasal cortical bone density values.

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ABSTRACT BACKGROUND: Bariatric surgery is the best treatment option for patients with obesity. As a result of the advancement of technology, the robotic gastric bypass presents promising results, despite its still high costs. AIMS: The aim of this study was to compare patients submitted to a robotic versus a laparoscopic gastric bypass at a single center by a single surgeon. METHODS: This retrospective study collected data from the medical records of 221 patients (121 laparoscopic procedures versus 100 with daVinci platform). The variables analyzed were sex, age, body mass index, comorbidities, surgical time, length of stay, and complications. RESULTS: The mean surgical time for patients in the robotic group was shorter (102.41±39.44 min versus 113.86±39.03 min, p=0.018). The length of hospital stay in robotic patients was shorter (34.12±20.59 h versus 34.93±11.74 h, p=0.007). There were no serious complications. CONCLUSIONS: The group submitted to the robotic method had a shorter surgical time and a shorter hospital stay. No difference was found regarding strictures, bleeding, or leakage.

RESUMO RACIONAL: A cirurgia bariátrica é a melhor opção de tratamento para pacientes portadores de obesidade. Em decorrência do avanço da tecnologia, o bypass gástrico robótico apresenta resultados promissores, apesar de seus custos ainda elevados. OBJETIVOS: Comparar pacientes submetidos a bypass gástrico robótico versus laparoscópico em um único centro por um único cirurgião. MÉTODOS: Estudo retrospectivo com coleta de dados dos prontuários de 221 pacientes (121 procedimentos laparoscópicos vs 100 com plataforma daVinci). As variáveis analisadas foram sexo, idade, IMC, comorbidades, tempo cirúrgico, tempo de internação e complicações. RESULTADOS: O tempo cirúrgico médio dos pacientes do grupo robótico foi menor (102,41 ± 39,44 min. vs 113,86±39,03 min, p=0,018). O tempo de internação em pacientes robóticos foi menor (34,12±20,59 h vs 34,93±11,74 h, p=0,007). Não houve complicações graves. CONCLUSÕES: O grupo submetido ao método robótico apresentou menor tempo cirúrgico e menor tempo de internação. Nenhuma diferença foi encontrada na amostra em relação a estenoses, sangramento ou vazamento.

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Objective: Assess the incidence of anaphylaxis in the emergency room (ER) of a private pediatric hospital in the city of São Paulo, Brazil, and describe associated factors. Method: This was a cross-sectional, retrospective, and observational study based on the medical records of patients from 0 to 18 years old seen at the emergency unit during the years of 2016-2019, who had a diagnosis potentially related to anaphylaxis according to ICD-10. All medical records were individually reviewed for the presence of compatible signs and symptoms that identified "possible" cases of anaphylaxis. Cases were considered probable anaphylaxis when medical history was compatible and indicative of anaphylaxis in the opinion of at least 2 allergists. Results: The incidence of anaphylaxis was 0.013%. Among the 56 patients identified (mean age 4.2 years), food was the most predominant suspected factor (53%), followed by unknown factors (32%), and drugs (12.5%). All patients presented with cutaneous symptoms, 74% with respiratory, and 53% with gastrointestinal. Allergic disease as a comorbidity was found in 39% of the children and 11% had a history of previous anaphylaxis. There were neither cases of syncope or shock, nor deaths. Intramuscular (IM) adrenaline was prescribed in 37.5% of cases. Conclusions: The incidence of anaphylaxis was low when compared to the worldwide incidence. The severity of most cases was mild, cutaneous symptoms were predominant, and food was the suspected trigger most frequently associated with reactions.

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INTRODUCTION: The cervical vertebral maturation (CVM) method comprises 6 stages reported to be prepubertal (1 and 2), pubertal (3 and 4) and postpubertal (5 and 6), and its use has been recommended for planning treatment timing in orthodontics. Reliable use of the method implies that pubertal stages have to mature into postpubertal as soon as the growth peak is terminated. The present study was aimed at determining whether postpubertal CVM stages 5 or 6 are attained in all subjects. METHODS: A total of 450 adult subjects (270 females and 180 males; mean age, 30.4 ± 27.3 years; range, 20-45 years) seeking orthodontic treatment and having a lateral head film were included in the study. Customized cephalometric analysis was used, and each recording was converted into an individual CVM code according to the concavities of the C2 to C4 and shapes of C3 and C4. The retrieved CVM codes, either falling within the reported norms (regular cases) or not (exception cases), were also converted into the CVM stages and a newly introduced CVM score (0-9) capable of defining intermediate stage. RESULTS: The most frequent CVM stage was 5, while the CVM stage 6 was attained in only one third of the sample. Up to about 11% of adult subjects showed the pubertal CVM stage 4. Irrespective of the CVM stage or CVM score, no significant differences were seen between the sexes or across ages. The C4 showed a rectangular vertical shape in only 16.4% of the cases. CONCLUSIONS: The percentage of adult population maintaining a pubertal CVM stage 4 is not high, but still relevant from a clinical standpoint. In light of this finding, planning treatment timing-based only on CVM appears not fully reliable.

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