Assuntos
Parede Abdominal , Abdominoplastia , Síndrome do Abdome em Ameixa Seca , Procedimentos Cirúrgicos Robóticos , Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Adulto , Herniorrafia , Humanos , Síndrome do Abdome em Ameixa Seca/complicações , Síndrome do Abdome em Ameixa Seca/cirurgiaRESUMO
PURPOSE: The enhanced view totally extraperitoneal (eTEP) concept first applied to inguinal hernias has become an important tool in the armamentarium of ventral hernia repair. The purpose of this report is to date the first brazilian robotic-assisted eTEP ventral hernia repair case series. METHODS: A review of a prospectively maintained database was conducted in patients who underwent robotic-assisted enhanced view totally extraperitoneal (eTEP) for ventral hernia repair between June 2018 and January 2020. Patients demographics, preoperative hernia characteristics, intraoperative variables and postoperative outcomes were evaluated. RESULTS: Our review identified 74 patients submitted to the procedure. Thirty-one patients (41.8%) presented primary ventral hernias (PVHs) and 43 patients (58.2%) presented incisional hernias (IHs). Female patients were predominant in both groups PVHs and IHs with 17 (22.9%) and 22 (29.7%) respectively, with a total of 39 patients (52.7%). Mean BMI was 29.1 kg/m2 (range 21.3-48.0 kg/m2) with higher mean BMI rates of 30.3 kg/m2 in the IHs group (range 22-48 years). A lateral dock setup was utilized in 55 cases (74.4%), having the inferior and superior dock setup in 18 (24.3%) and 1 (1.3%) cases respectively. Mean console time was 148.3 (range 75-277 min) and 192.6 min (range 66-301 min) in the PVHs and IHs groups respectively. There were no intraoperative complications or conversions. Average length of stay was 1.5 days. Four patients were readmitted within 30 days of surgery. There were no reoperation or cases of intraparietal herniation in this cohort. No hernia recurrence was verified during the mean 230.7 days of follow up in both groups. CONCLUSION: We present the first brazilian series to-date of the robotic assisted eTEP approach for ventral hernia repairs. Although long term outcomes require further analysis, its feasibility and reproducibility in experienced surgeons hands are evident, with safe and acceptable early postoperative outcomes.
Assuntos
Hérnia Ventral , Hérnia Incisional , Laparoscopia , Procedimentos Cirúrgicos Robóticos , Feminino , Hérnia Ventral/cirurgia , Herniorrafia/efeitos adversos , Humanos , Hérnia Incisional/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Telas CirúrgicasRESUMO
BACKGROUND AND AIMS: Macrophages derived from monocytes play an important role in atherosclerosis progression. Subpopulations of circulating classical, intermediate, and non-classical monocytes possess distinct functions and phenotypes, and participate in the pathogenesis of disease. The aim of this study was to compare the quantity and phenotypes of circulating monocyte subpopulations in patients with established atherosclerosis and healthy control individuals. Additionally, the study aimed to provide insight into the functional activity of monocytes against a heat shock protein (HSP60). METHODS: Chemokine and pattern recognition receptors in monocyte subsets obtained from peripheral blood of acute and chronic coronary artery disease patients and controls were quantified by flow cytometry. Furthermore, monocytes from healthy controls were stimulated in vitro with HSP60, and the cytokines produced by them were evaluated by flow cytometry. RESULTS: Eighteen controls (C), 34 individuals with risk factors for cardiovascular disease (RF), 32 patients with stable angina (SA), and 16 patients with unstable angina (UA) were enrolled in the study. The absolute count of intermediate monocytes was found to be increased in patients of the UA group; high frequencies of the chemokine receptors CCR2, CCR5, and CX3CR1 were also observed in this subpopulation. Moreover, the pattern recognition receptors TLR2 and TLR4 were more frequent in intermediate monocytes from the UA group. Furthermore, the intermediate monocytes from healthy individuals produced IL-12p70 after stimulation with HSP60. CONCLUSIONS: Our results show that intermediate monocytes of UA patients exhibited an enhanced expression of the receptors involved in the recognition of damage-associated molecular patterns (DAMPs) and enhancement of the migratory function. Hence, they might contribute to the propagation and progression of inflammation observed in atherosclerosis, especially in the acute setting.
Assuntos
Angina Instável/metabolismo , Quimiocinas/metabolismo , Monócitos/metabolismo , Receptores de Reconhecimento de Padrão/metabolismo , Receptor 1 de Quimiocina CX3C/metabolismo , Chaperonina 60/metabolismo , Feminino , Humanos , Interleucina-12/metabolismo , Masculino , Pessoa de Meia-Idade , Receptores CCR2/metabolismo , Receptores CCR5/metabolismo , Receptor 2 Toll-Like/metabolismo , Receptor 4 Toll-Like/metabolismoRESUMO
Exposure to aluminum (Al) and aluminumâ¯+â¯manganese (Mn) can trigger an increase in reactive oxygen species (ROS) and modify the activity of oxidative defense enzymes. This study investigated whether exposure to Al and Alâ¯+â¯Mn at acid pH for 24 and 96â¯h causes oxidative stress evidenced by antioxidants and oxidative damage in the gills and liver of sexually mature Astyanax altiparanae males. The fish were subsequently immersed in metal-free water for 24 and 96â¯h to see whether they recovered from the effects of these metals. Exposure to an acid pH boosted the activity of gill superoxide dismutase (SOD) at 96â¯h and the fish did not recover when immersed for the same period in water at neutral pH. Exposure to Al increased glutathione (GSH) levels (24â¯h) in the gills, returning to control levels during the recovery period, showing the efficiency of the antioxidant system in preventing lipid peroxidation of the gills and liver. Mn did not modify the activity of the enzymes studied, but did trigger late hepatic lipid peroxidation during the recovery period. The group exposed to Alâ¯+â¯Mn exhibited several alterations, including increased concentration of GSH, as well as higher GPx and GR activity in the gills. Despite the defensive responses triggered by acute exposure, during the recovery period there were alterations in catalase (96â¯h) and an increase in hepatic metallothionein (24â¯h), but this did not prevent hepatic lipid peroxidation. Al and Alâ¯+â¯Mn produced different effects, and the timing of enzymatic and non-enzymatic antioxidant defenses also differed.
Assuntos
Alumínio/toxicidade , Characidae/fisiologia , Brânquias/efeitos dos fármacos , Fígado/efeitos dos fármacos , Manganês/toxicidade , Estresse Oxidativo/efeitos dos fármacos , Poluição Química da Água/efeitos adversos , Adaptação Fisiológica , Animais , Catalase/metabolismo , Sinergismo Farmacológico , Proteínas de Peixes/agonistas , Proteínas de Peixes/metabolismo , Brânquias/enzimologia , Brânquias/metabolismo , Glutationa/agonistas , Glutationa/metabolismo , Concentração de Íons de Hidrogênio , Peroxidação de Lipídeos/efeitos dos fármacos , Fígado/enzimologia , Fígado/metabolismo , Masculino , Metalotioneína/metabolismo , Reprodutibilidade dos Testes , Superóxido Dismutase/química , Superóxido Dismutase/metabolismo , Testes de Toxicidade AgudaRESUMO
BACKGROUND: The introduction of the minimally invasive approach changed the way abdominal surgery was carried out. Open suture and mesh reinforcement in ventral hernia repair used to be the surgeon's choice of procedure. Although the laparoscopic approach, with defect bridging and mesh fixation, has been described since 1993, the procedure remains largely unchanged. Evidence shows that defect closure and retro-muscular mesh positioning have the best outcomes and are the best surgical practice. We therefore aimed to develop and demonstrate a procedure which combined the good results of open surgery using the Rives-Stoppa principles, particularly in terms of recurrence, with all the benefits of minimally invasive surgery. METHODS: Between October 2012 and February 2014, 15 post-bariatric surgery patients underwent laparoscopic midline incisional hernia repair. The peritoneal cavity was accessed through a 5-mm optical view cannula at the superior left quadrant. A suprapubic and two right and left lower quadrant cannulas were inserted for inferior access and dissection. The defect adhesions were released. The whole midline was closed with an endoscopic linear stapler, including the defect, from the lower abdomen, 4 cm below the umbilicus, until the epigastric region, including posterior sheath mechanical suturing and cutting in the same movement. A retrorectus space was created in which a retro-muscular mesh was deployed. Fixation was done using a hernia stapler against the posterior sheath from the peritoneal cavity to the abdominal wall muscles. Selection was based on xifo-umbilical incisional midline hernias post open bariatric surgery. Pregnant women, cancer patients, or patients with clinical contraindications were excluded. RESULTS: The patients mean age was 51.2 years (range 39-67). Four patients were men and eleven women. Two had well-compensated fibromyalgia, four had diabetes, and five had hypertension. The mean BMI was 29.5 kg/m2 (range 23-31.6). Surgery was performed successfully in all cases through four ports; the number of incisional hernias was 3 ± 2, with a mean maximum width of 3.75 cm (range 2.1-9) and maximum length of 14 cm (7.5-20.5). The mean surgical time was 114.3 min (range 85-170), and the median hospital stay was 1.4 days. No intra-operative or immediate post-operative complication or death occurred. One patient had a seroma treated conservatively 1 week after surgery and another had a retro-muscular infection treated with percutaneous drainage. CT-Scans made before and after the procedure, showed total closure of the defect. QOL questionnaire showed satisfaction, acceptance, and no complaints. CONCLUSION: Although the study involved a small number of patients, it has proved the technique to be feasible, easy to perform, and have the combined benefits of laparoscopic and open surgery. The results, shown by CT-scan, peri-operative, and QOL findings, were good.
Assuntos
Técnicas de Fechamento de Ferimentos Abdominais , Cirurgia Bariátrica/efeitos adversos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Hérnia Incisional/cirurgia , Parede Abdominal/cirurgia , Adulto , Idoso , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos de Cirurgia Plástica/métodos , Reto do Abdome/cirurgia , Telas CirúrgicasRESUMO
Stress fractures are common in athletes, and their incidence in sport is estimated at 2-4%. A case is reported of a stress fracture of the sacrum in an amateur tennis player. The patient was treated with rest and physiotherapy, focusing on stretching programmes and analgesic treatments, followed by an educational programme of tennis training and muscle strengthening. This appears to be the first report of this pathology in a tennis player.
Assuntos
Fraturas de Estresse/etiologia , Sacro/lesões , Tênis/lesões , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/terapia , Humanos , Dor Lombar/etiologia , Dor Lombar/terapia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Resultado do TratamentoRESUMO
BACKGROUND: Tears of the rotator cuff tendons, which surround the joints of the shoulder, are one of the most common causes of pain and disability in the upper extremity. OBJECTIVES: To review the efficacy and safety of common interventions for tears of the rotator cuff in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised trail register (July 2002), the Cochrane Controlled Trials Register (The Cochrane Library issue 2, 2002), MEDLINE (1966 to December 2001), EMBASE (1974 to December 2001), Biological Abstracts (1980 to December 2001), LILACS (1982 to December 2001), CINAHL (November 1982 to December 2001), Science Citation Index and reference lists of articles. We also contacted authors and handsearched conference proceedings focusing on shoulder conditions. SELECTION CRITERIA: Randomised or quasi-randomised clinical trials involving tears of the rotator cuff were the focus of this review. All trials involving conservative interventions or surgery were included (non-steroidal anti-inflammatory drugs, intra-articular or subacromial glucocorticosteroid injection, oral glucocorticosteroid treatment, physiotherapy, and open or arthroscopic surgery). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed suitability for inclusion, methodological quality and extracted data. Dichotomous data were presented as relative risks (RR) and 95% confidence intervals (CI), using the fixed effects model. MAIN RESULTS: Eight trials involving 455 people were included and 393 patients analysed. Trials were grouped in eight categories of conservative or surgical treatment. The median quality score of all trials combined was 16 out of a possible 24 points, with a range of 12-18. In general, included trials differed on diagnostic criteria for rotator cuff tear, there was no uniformity in reported outcome measures, and data which could be summarised were rarely reported. Only results from two studies comparing open repair to arthroscopic debridement could be pooled. There is weak evidence for the superiority of open repair of rotator cuff tears compared with arthroscopic debridement. REVIEWER'S CONCLUSIONS: There is little evidence to support or refute the efficacy of common interventions for tears of rotator cuff in adults. As well as the need for further well designed clinical trials, uniform methods of defining interventions for rotator cuff tears and validated outcome measures are also essential.
Assuntos
Lesões do Manguito Rotador , Adulto , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Ruptura/terapiaRESUMO
The aim of this study was to compare the inguinal area, known as "Hessert's triangle", in patients undergoing surgical treatment for inguinal hernia with the area in fresh cadavers without hernia. The 73 cadavers, which were not fixed in formalin, were examined within 15 h post mortem. A total of 132 measurements were made in these cadavers and compared with 130 measurements in 115 hernia patients. The average age was 44.2 years for patients and 32.7 years for cadavers. The mean height and weight were 1.68 m and 69.9 kg for hernia patients and 1.67 m and 70.0 kg for the cadavers, respectively. The mean area of Hessert's triangle was 8.97 cm2 (range 2.28-29.62 cm2) in the hernia patients and 2.95 cm2 (range 1.37-5.92 cm2) in the cadavers. This difference was statistically significant (P < 0.00). A larger triangle is created by a higher intersections of the internal oblique and transversus muscles and its aponeurosis to the rectus sheath. When these muscles contract, they move toward the inguinal ligament to occlude the triangle, but with a larger triangle, the occlusion is incomplete. Our anatomical measurements verified that the size of Hessert's triangle is an important factor in the etiology of inguinal hernia.
Assuntos
Músculos Abdominais/anatomia & histologia , Hérnia Inguinal/etiologia , Canal Inguinal/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cadáver , Feminino , Hérnia Inguinal/cirurgia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-IdadeRESUMO
Since the introduction of H2 receptor antagonists and inhibitors of the acid pump, the indications for the surgical management of peptic disease have decreased significantly. However some patients presenting bleeding, perforation, gastric outlet obstruction and intractable peptic ulcer still need surgical treatment. The first laparoscopic Billroth II gastrectomy was performed in 1992. To date, laparoscopic gastrectomy has been performed by a small number of surgeons around the world. The aim of this study was to present a case of totally laparoscopic Billroth II gastrectomy and to describe an alternative technique using endoscopic stapling devices. We present a case of a 48-year-old man, complaining of severe epigastralgia, who had a 20-year history of peptic ulcer. Gastroscopy had revealed a duodenal ulcer and a deformity of the bulbus. A diagnosis of intractable peptic ulcer was made, and the patient underwent laparoscopic Billroth II gastrectomy with side-to-side intracorporeal gastrojejunostomy using endoscopic stapling devices. On postoperative day 1, he was able to walk. On postoperative day 3, he started on a clear liquid diet and was discharged on postoperative day 6. During his postoperative recovery, the patient experienced little pain and did not request narcotic analgesia. Laparoscopic gastric resection is an alternative to open procedure in well selected cases.
Assuntos
Gastrectomia/métodos , Gastroenterostomia/métodos , Laparoscopia , Úlcera Péptica/cirurgia , Cirurgia Vídeoassistida , Humanos , Jejuno/cirurgia , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/complicações , Estômago/cirurgiaRESUMO
Os autores estudaram retrospectivamente 89 pacientes submetidos a meniscectomia lateral parcial artroscópica, entre 1984 e 1993, selecionados segundo critérios de ausência de lesao ligamentar associada, ausência de sinais de degeneraçao articular confirmados quando realizada artroscopia, sem queixas anteriores relacionadas com a patologia meniscal lateral. Dos pacientes, 37 (41,57 por cento) foram avaliados segundo questionário e os 52 (58,43 por cento) restantes, analisados também clínica e radiograficamente. Foi realizada associaçao entre o tipo de lesao e evoluçao clínica. Encontraram pior evoluçao desde o início para volta às atividades pregressas nos casos em que a meniscectomia era mais abrangente, princippalmente da regiao do tendao poplíteo até o corno posterior, nas lesoes longitudinais com ressecçao de mais de 1/3 do menisco. Observaram clara piora de evoluçao clínica com o tempo de seguimento. O estudo radiográfico mostrou sinais incipientes de artrose lateral principalmente nos pacientes com maior seguimento e maior atividade física. O outro achado relacionado com pior evoluçao foi o aparecimento de amolecimento ou fissura cartilagínea no compartimento lateral, no momento da meniscectomia parcial artroscópica. Os autores concluíram que a meniscectomia lateral parcial pode apresentar evoluçao precocemente sintomática, principalmente nas lesoes longitudinais posteriores e extensas, em atletas de grande atividade, podendo piorar ao longo do tempo.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Meniscos Tibiais/cirurgia , Artroscopia , Seguimentos , Meniscos Tibiais , Resultado do TratamentoRESUMO
To verify whether there is a state of phosphate depletion in dehydrated infants with diarrhea and whether phosphate administration affects recovery from metabolic acidosis, two groups of infants were studied. All were males, from 1 to 7 months old, and in good nutritional state. The control group was treated with a standard regimen of I.V. fluids initially, followed by feedings of a diluted milk formula starting on the 2nd day of treatment. The study group, in addition to this standard regimen, received sodium phosphate (Na2HPO4/Na2HPO4, 4:1, pH 7.4), initially by the I.V. route and thereafter orally with the feedings, at the dose of 2mM/kg/day. During the first 6 days of treatment, daily electrolyte (Na, K, Ca, Mg. Cl and P) and nitrogen balances were recorded. Hydrogen ion excretion (NH4 + TA--HCO3) was determined daily. Clinical findings and course were similar in the two groups. No untoward effects were observed with phosphate administration. In the control group, P balance was negative during all the periods and losses were in excess of those expected from nitrogen losses, thus suggesting a state of depletion. In the P-treated group however, P retention was not demonstrated in the first 2 days, finding a not suggestive of a P depleted state. Linear regressions between both daily and cumulative balances of P-nitrogen-free and Ca indicated a close correlation, thus suggesting that these two ions are mobilized concommitantly.