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1.
Int. j. morphol ; 38(3): 552-557, June 2020. tab, graf
Article in Spanish | LILACS (Americas) | ID: biblio-1098286

ABSTRACT

La colecistectomía laparoscópica es el tratamiento de elección de la colelitiasis; sin embargo, se acompaña de comorbilidades y no está exenta de complicaciones mayores que pueden ser letales; la identificación del trígono cistohepático con disección y ligadura de la arteria cística son pasos obligatorios de la cirugía; la identificación de las variaciones de la arteria cística y los conductos biliares pueden minimizar las eventuales complicaciones. Al protocolo preoperatorio se implementó una angiotomografía con Tomógrafo Siemens Somatón Sensation ® de 64 cortes para identificar la arteria cística en pacientes con colelitiasis de la Unidad de Cirugía General del Hospital de Especialidades Teodoro Maldonado Carbo IESS de Guayaquil. Se escogieron 60 pacientes femeninos en forma aleatoria (edades 19-70 años, promedio 44,25 años) y la muestra se dividió en dos grupos de 30; al grupo estudio se aplicó angiotomografía hasta un mes antes de la cirugía y al grupo control se le aplicó el protocolo convencional. Se evaluó morbilidades relacionadas con: hemorragia operatoria por lesión de la arteria cística y en el posoperatorio: infección de herida operatoria, íleo y drenaje. La angiotomografía permitió identificar la arteria cística en el preoperatorio y contribuyó a disminuir comorbilidades que acompañan a la colecistectomía laparoscópica.


Laparoscopic cholecystectomy is the treatment of cholelithiasis of choice; however, it is accompanied by comorbidities and is not exempt from major complications that can be lethal; the identification of the cystohepatic trigone with dissection and ligation of the cystic artery are mandatory steps of surgery; the identification of the variations of the cystic artery and the bile ducts can minimize the possible complications. The preoperative protocol was implemented with an angiotomography with Siemens Somatón Sensation ® 64-slice Tomograph to identify the cystic artery in patients with cholelithiasis of the General Surgery Unit of the Teodoro Maldonado Carbo IESS Specialty Hospital of Guayaquil. 60 female patients were chosen at random (ages 19 -70 years, average 44.25 years) and the sample was divided into two groups of 30; Angiotomography was applied to the study group up to one month before surgery and the conventional protocol was applied to the control group. Morbidities related to: operative haemorrhage due to cystic artery and postoperative injury: operative wound infection, ileus and drainage were evaluated. Angiotomography allowed to identify the cystic artery in the preoperative period and contributed to decrease comorbidities that accompany laparoscopic cholecystectomy.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Young Adult , Cholelithiasis/surgery , Celiac Artery/diagnostic imaging , Computed Tomography Angiography/methods , Postoperative Complications/prevention & control , Preoperative Care , Cholelithiasis/diagnostic imaging , Comorbidity , Celiac Artery/anatomy & histology , Cholecystectomy, Laparoscopic
2.
Rev. Hosp. Ital. B. Aires (2004) ; 40(1): 4-10, mar. 2020. ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1100756

ABSTRACT

Se realizó un estudio prospectivo y descriptivo, incluyendo 103 pacientes que fueron tratados por cáncer de laringe en etapa inicial (T1-T2) con cirugía transoral. De ellos, 55 se diagnosticaron en estadio T1, 16 en estadio T1-b y 32 en estadio T2. El control local inicial (CLI) en pacientes con tumores malignos de laringe estadificados T1 fue 91%, el control local con rescate (CLR) 96%, la preservación de la función de la laringe (PFL) 93% y la sobrevida específica 96%. En T1-b, el CLI fue 81%, el CLR 94%, la PFL 94% y la sobrevida específica 94%. En T2, el CLI fue 63%, el CLR 94%, la PFL 72% y la sobrevida específica 78%. La cirugía transoral en cáncer de laringe con T inicial tiene resultados oncológicos similares a otros tratamientos (cirugía externa o radioterapia), pero consideramos que es la mejor opción por su baja morbilidad, menor duración del tratamiento, y porque deja abiertas todas las posibilidades para tratar posibles recurrencias. (AU)


A prospective and descriptive study was conducted, including 103 patients who were treated for early stage laryngeal cancer (T1-T2) with transoral surgery. Of these, 55 were diagnosed in stage T1, 16 in stage T1-b and 32 in stage T2. The initial local control (CLI) in patients with malignant T1 laryngeal tumors was: 91%, local control with rescue (CLR) 96%, preservation of larynx function (PFL) 93% and specific survival 96%. In T1-b the CLI was 81%, the CLR 94%, the PFL 94% and the specific survival 94%. In T2 the CLI was 63%, the CLR 94%, the PFL 72% and the specific survival 78%. Transoral surgery in laryngeal cancer with initial T has oncological results similar to other treatments (external surgery or radiotherapy), but we consider that it is the best option because of its low morbidity, shorter duration of treatment, and because it leaves open all the possibilities to treat possible recurrences. (AU)


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Laryngeal Neoplasms/surgery , Neoplasm Recurrence, Local/prevention & control , Postoperative Complications/prevention & control , Surgical Procedures, Operative/methods , Vocal Cords/pathology , Voice Quality , Tracheostomy/statistics & numerical data , Laryngeal Neoplasms/classification , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/physiopathology , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/radiotherapy , Prospective Studies , Epiglottis/pathology , Duration of Therapy , Intubation, Gastrointestinal/statistics & numerical data
3.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 12: 971-976, jan.-dez. 2020. graf, tab
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-1119071

ABSTRACT

Objetivos: Identificar os fatores de risco pré e pós-operatórios relacionados ao desenvolvimento de mediastinite entre pacientes submetidos à cirurgia cardíaca em um hospital da cidade do Rio de Janeiro, caracterizar a população estudada e analisar a relação entre os fatores de risco e a incidência de mediastinite nos pacientes submetidos à cirurgia cardíaca. Método: Estudo descritivo, abordagem quantitativa, em que foram identificados os fatores de risco para mediastinite em pacientes que realizaram cirurgia cardíaca em um hospital do Rio de Janeiro. Resultados: Obteve-se um n de 192 pacientes, de maioria homens, na faixa etária de 50 a 69 anos e em sobrepeso. Diabetes mellitus e tabagismo foram as comorbidades mais frequentes, e CRVMC a cirurgia mais realizada, 4 pacientes apresentaram mediastinite. Conclusão: A identificação destes fatores contribui para elaboração de estratégias de prevenção para mediastinite, e na implementação de cuidados de enfermagem no pré e pós-operatório de cirurgias cardíacas


Objectives: To identify pre and postoperative risk factors related to the development of mediastinitis among patients submitted to cardiac surgery at a hospital in the city of Rio de Janeiro, to characterize the study population and to analyze the relationship between risk factors and the incidence of mediastinitis in patients undergoing cardiac surgery. Method: descriptive study, quantitative approach, in which the risk factors for mediastinitis were identified in patients who underwent cardiac surgery in a hospital in Rio de Janeiro. Results: a n of 192 patients, mostly males, aged 50 to 69 years and overweight were obtained. Diabetes mellitus and smoking were the most frequent comorbidities, and CRVMC the most performed surgery, 4 patients had mediastinitis. Conclusion: the identification of these factors contributes to the elaboration of prevention strategies for mediastinitis, and the implementation of nursing care in the pre and postoperative period of cardiac surgeries


Objetivos: Identificar los factores de riesgo pre y postoperatorios relacionados al desarrollo de mediastinitis entre pacientes sometidos a la cirugía cardiaca en un hospital de la ciudad de Río de Janeiro, caracterizar a la población estudiada y analizar la relación entre los factores de riesgo y la incidencia de mediastinitis en los pacientes sometidos a la cirugía cardiaca. Método: Estudio descriptivo, abordaje cuantitativo, en que se identificaron los factores de riesgo para la mediastinitis en pacientes que realizaron una intervención cardiaca en un hospital de Río de Janeiro. Resultados: Se obtuvo un n de 192 pacientes, de mayoría hombres, en el grupo de edad de 50 a 69 años y en sobrepeso. La diabetes mellitus y el tabaquismo fueron las comorbilidades más frecuentes, y CRVMC la cirugía más realizada, 4 pacientes presentaron mediastinitis. Conclusión: La identificación de estos factores contribuye a la elaboración de estrategias de prevención para la mediastinitis, y en la implementación de cuidados de enfermería en el pre y postoperatorio de cirugías cardíacas


Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Middle Aged , Aged , Postoperative Complications/prevention & control , Thoracic Surgery/statistics & numerical data , Mediastinitis/epidemiology , Postoperative Complications/epidemiology , Surgical Wound Infection/complications , Retrospective Studies , Risk Factors , Mediastinitis/complications
4.
Cuenca; s.n; Universidad de Cuenca; 2020. 41 p. ilus; tab. CD-ROM.
Thesis in Spanish | LILACS (Americas) | ID: biblio-1102646

ABSTRACT

Abstract: Background: hernia is one of the most frequent pathologies in General Surgery, a common reason for surgical consultation, the resolution of this pathology currently has extensive debates about the surgical approach related to open or laparoscopic hernioplasty, with advantages and disadvantages exposed to each. Objective: to determine the prevalence and factors associated with complications of inguinal posthernioplasty at the Vicente Corral Moscoso and José Carrasco Arteaga Hospitals, 2018-2019.Material and methods: It's analytical, cross-sectional study. 240 clinical records that met the inclusion criteria were reviewed. Data were collected using a form and were tabulated in the SPSS version 15 program. The qualitative variables were analyzed with frequency and percentage and the quantitative variables with arithmetic mean and standard deviation, the associated factors were analyzed with Odds Ratio, 95% CI, Chi square and binary logistic regression (p <0.05).Results: 240 patients who had the inclusion criteria were analyzed, the majority were men (81.7%), the mean age was 53.4 years SD ± 16.57. The prevalence of postoperative complications was 27.5%, with those occurring within the first 24 hours being more frequent with 15.8%. Among the factors associated with statistical significance were: male sex (OR 4.6; 95% CI 1.5-13.5; p <0.00) and surgical technique (OR 3.4; 95% CI 1.2-9; p <0.01).Conclusions: prevalence of postoperative complications was similar to the literature consulted and was associated with factors such as: male sex and surgical technique.


Subject(s)
Humans , Female , Middle Aged , Herniorrhaphy/instrumentation , Hernia, Inguinal/diagnosis , Postoperative Complications/prevention & control , Contraindications, Procedure
5.
Rev Rene (Online) ; 21: 43167, 2020. tab
Article in English, Portuguese | LILACS (Americas), BDENF | ID: biblio-1087328

ABSTRACT

Objetivo: identificar a realização de atividades congruentes com os padrões de qualidade dos cuidados de enfermagem por enfermeiros especialistas em enfermagem médico-cirúrgica, no contexto hospitalar. Métodos: estudo descritivo, concretizado em 36 hospitais, no qual participaram 259 enfermeiros especialistas em enfermagem médico-cirúrgica. Para coleta de dados, usou-se de questionário, posteriormente analisado por meio de estatística descritiva. Resultados: os enfermeiros participantes avaliaram com melhores escores as atividades relativas às dimensões responsabilidade e rigor, satisfação do cliente e prevenção de complicações; e com menores escores, as atividades integradas nas dimensões promoção da saúde, readaptação funcional e bem-estar e autocuidado. Conclusão: embora os achados evidenciem atuação dos enfermeiros especialistas na área de enfermagem médico-cirúrgica que tende a ser coerente com os padrões de qualidade, sinalizaram-se lacunas no exercício profissional e potencialidades que podem subsidiar o processo de qualificação desses profissionais, alertar os gestores e qualificar a assistência de enfermagem. (


Objective: to identify the performance of activities con-gruent with the quality standards of nursing care by expert nurses in medical-surgical nursing, in the hospital context. Methods: a descriptive study, carried out in 36 hospitals, in which 259 nurses specialized in medical-surgical nursing participated. For data collection, a questionnaire was used, later analyzed using descriptive statistics. Results: the par-ticipating nurses evaluated activities related to the dimen-sions of responsibility and rigor, customer satisfaction and prevention of complications with better scores; and with lo-wer scores, activities integrated in the dimensions of health promotion, functional readaptation and well-being and self--care. Conclusion: although the findings show the perfor-mance of expert nurses in the medical-surgical nursing area that tends to be consistent with quality standards, gaps in professional practice and potentialities that can support the qualification process of these professionals were signaled, alert managers and qualify nursing care


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality Assurance, Health Care , Medical-Surgical Nursing , Hospitals , Nursing Care , Portugal , Postoperative Complications/prevention & control , Self Care , Patient Satisfaction , Health Promotion , Intraoperative Complications/prevention & control
6.
Rev. ADM ; 76(5): 267-271, sept.-oct. 2019. ilus, tab
Article in Spanish | LILACS (Americas) | ID: biblio-1053026

ABSTRACT

Introducción: La odontectomía del tercer molar produce una respuesta metabólica al trauma quirúrgico caracterizada por una importante infl amación del área, por lo que para su control se cuenta con diferentes opciones terapéuticas como la farmacoterapia, crioterapia y laserterapia, así como otras alternativas como la compresión de la región, cuya propuesta presentada en este trabajo es a través de la utilización de un apósito adhesivo facial. Objetivo: Evaluar la efi cacia de la aplicación de un apósito adhesivo facial para el control de la infl amación postquirúrgica de la odontectomía del tercer molar. Material y métodos: Se realizó un ensayo clínico controlado de fase I multicéntrico. Se conformó un grupo de estudio experimental y de control con 10 participantes en cada uno, de ambos sexos, de 18-30 años de edad, sanos y que presentaron un tercer molar inferior izquierdo retenido vertical o mesioangular, clase I o II, posición A o B (Pell y Gregory). Se efectuaron las odontectomías bajo anestesia local y sólo en el grupo experimental se utilizó un apósito adhesivo transparente marca Tegaderm® de 3M, el cual se colocó sobre la mejilla de los pacientes durante 48 horas. La evaluación de la infl amación se realizó con el método de Laskin modifi cado previo al procedimiento, a las 48 horas y en el quinto día postoperatorio. Resultados: El promedio de la longitud de la línea 1 a las 48 horas y al quinto día postoperatorio en el grupo experimental fue menor que en el grupo control siendo las diferencias estadísticamente signifi cativas. En el resto de las líneas, la longitud promedio también fue menor en el grupo experimental; sin embargo, no se encontraron diferencias estadísticamente signifi cativas. Conclusión: Este ensayo clínico no es concluyente respecto a la efi cacia del apósito adherible facial para reducir la infl amación postquirúrgica de la odontectomía del tercer molar (AU)


Introduction: The third molar odontectomy produces a metabolic response to surgical trauma characterized by an important infl ammation of the area, so that, for its control, it has diff erent therapeutic options as the pharmacotherapy, cryotherapy and laser therapy, as well as other alternatives such as compression of the region, whose proposal presented in this work is using a facial adhesive dressing. Objective: Evaluate the eff ectiveness of the implementation of a facial adhesive dressing for the control of postsurgical infl ammation of the third molar odontectomy. Material and methods: It has been made a controlled clinical trial of phase I multicentric. It formed a group of experimental and control study with 10 participants in each one, of both sexes, 18- 30 years of age, healthy and that presented a lower left third molar retained vertical or mesioangular, class I or II, position A or B (Pell and Gregory). Odontectomy were performed under local anesthesia and only in the experimental group used a transparent fi lm dressing Tegaderm® by 3M which was placed on the cheek of the patients for 48 hours. The evaluation of the infl ammation was performed with the method of Laskin modifi ed prior to the procedure, at 48 hours and on the 5th postoperative day. Results: The average of the length of the line 1 to 48 hours and at the 5th postoperative day was lower in the experimental group than in the control group, the diff erences being statistically signifi cant. In the rest of the lines, the average length was also lower in the experimental group, however, there were no statistically signifi cant diff erences. Conclusion: This trial is not conclusive as to the eff ectiveness of the dressing stick coating facial to reduce the postsurgical infl ammation of the third molar odontectomy (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Osteotomy , Pain, Postoperative/prevention & control , Bandages , Inflammation/prevention & control , Molar, Third/surgery , Postoperative Complications/prevention & control , Statistical Analysis , Mexico
7.
Acta cir. bras ; 34(10): e201901002, Oct. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1054669

ABSTRACT

Abstract Purpose: To evaluate the effect of garlic on formation of postoperative adhesions in rats. Methods: Twenty-four Sprague dawley rats were divided into three groups. In Group 1 (sham), laparotomy was performed and stitched up. In Group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and 2 cc of saline was intraperitoneally administered to each rat. In Group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Allium sativum derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum Results: In Group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. Conclusions: No positive outcomes indicating that Allium sativum reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, allium sativum increased the production of free oxygen radicals in the tissue.


Subject(s)
Animals , Peritoneal Diseases/prevention & control , Garlic/chemistry , Peritoneal Diseases/pathology , Postoperative Complications/pathology , Postoperative Complications/prevention & control , Fibrosis , Immunohistochemistry , Tissue Adhesions/pathology , Tissue Adhesions/prevention & control , Reproducibility of Results , Rats, Sprague-Dawley , Oxidative Stress/drug effects , Free Radicals/analysis , Laparotomy , Lymph Nodes/drug effects , Lymph Nodes/pathology
8.
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 338-342, July-Sept. 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1040026

ABSTRACT

Abstract Introduction The main modalities of surgical treatment for laryngeal cancer include transoral laser microsurgery (TLM), open preservation surgery, and total laryngectomy (TL). In the elderly, for the presence of comorbidities, the surgical approach more appropriate in many cases remains TL. The use of a stapler for the closure of the esophagus has been introduced to reduce surgical time and postoperative complications such as pharyngocutaneous fistula (PCF). Objective In the present study, we have evaluated the effectiveness of the use of the horizontal mechanical pharyngoesophageal closure in patients who underwent TL. Methods This nonrandomized study was performed on consecutive patients with histopathologically proven squamous cell endolaryngeal carcinoma. The TLwas performed using a linear stapler to mechanically suture the pharyngotomy using the semiclosed technique. Results A total of 33 patients underwent TL, and 13 of themunderwent neck dissection. A total of 15 patients (45.4%) were ≤70 years old, and 18 were > 70 years old. Analyzing the results in relation to age, patients > 70 years old showed tumors at an earlier stage than those aged ≤70 years old. Furthermore, in this group there was a greater number of patients who had comorbidities (p = 0.014). In total, we had 2 (6%) cases of PCF in 6.6% in the group ≤70 years old, and in 5.5% of the group > 70 years old (p = 1.00). Conclusions The use of the stapler for the horizontal closure of the pharyngoesophagectomy in the patients subjected to TL is proven to be useful and safe even when used in elderly patients.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/surgery , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Pharynx/surgery , Postoperative Complications/prevention & control , Surgical Staplers , Suture Techniques/instrumentation , Treatment Outcome , Cutaneous Fistula/prevention & control , Esophagus/surgery
9.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(2): 161-165, Apr.-June 2019. tab
Article in English | LILACS (Americas) | ID: biblio-1013280

ABSTRACT

ABSTRACT Objective: To investigate how symptoms vary according to the appendiceal position in pediatric patients and to demonstrate that the laparoscopic approach is safe and effective in any appendiceal location by comparing each location to another. Methods: The medical records of 1,736 children aged 14 or younger who underwent laparoscopic appendectomy over a period of 14 years were analyzed retrospectively. Patients were divided according to the position of the appendiceal tip into four groups: anterior, pelvic, retrocecal and subhepatic. The Kruskal-Wallis and chi-square tests were used with the Bonferroni correction, with a significant p<0.05. Results: The appendiceal location was anterior in 1,366 cases, retrocecal in 248 cases, pelvic in 66 cases and subhepatic in 56 cases. There were no significant differences between the groups in terms of patient age and gender. Abdominal pain was the only symptom with statistically significant differences between the groups. The rate of perforated appendicitis was higher in the subhepatic and pelvic positions. Intraoperative complications and conversions were not statistically significant. Technical difficulties and operative time were higher in subhepatic position. The rate of postoperative complications was similar between the different locations, except for bowel obstruction, which was higher in pelvic appendicitis. Conclusions: The clinical symptoms of appendicitis hardly ever change with the position of the appendix. The laparoscopic approach is safe and effective, regardless the appendiceal location.


RESUMO Objetivo: Investigar como os sintomas variam de acordo com a posição do apêndice em pacientes pediátricos e demonstrar que a laparoscopia é segura e eficaz em qualquer posição do apêndice, comparando-as. Métodos: Os prontuários de 1.736 pacientes pediátricos com idade ≤14 anos submetidos à apendicectomia laparoscópica em um período de 14 anos foram analisados retrospectivamente. Os pacientes foram divididos de acordo com a posição do apêndice: anterior, pélvica, retrocecal e sub-hepático. Os testes de Kruskal-Wallis e do qui-quadrado foram usados com a correção de Bonferroni, sendo significante p<0,05. Resultados: A posição do apêndice era anterior em 1.366 casos, retrocecal em 248 casos, pélvica em 66 casos e sub-hepática em 56 casos. Não houve diferenças significativas entre os grupos quanto às variáveis idade e sexo. A dor abdominal foi a única variável com diferenças estatisticamente significantes entre os grupos. A taxa de apêndice perfurado foi superior nas posições sub-hepática e pélvica. As complicações intraoperatórias e a taxa de conversão não foram estatisticamente significativas. As dificuldades técnicas e o tempo cirúrgico foram superiores em posição sub-hepática. A taxa de complicações pós-operatórias foi semelhante entre as diferentes posições, exceto a obstrução intestinal, que foi superior em posição pélvica. Conclusões: Os sintomas da apendicite dificilmente variam com a posição do apêndice. A laparoscopia é segura e eficaz, independentemente da posição do apêndice.


Subject(s)
Humans , Male , Female , Child , Adolescent , Appendicitis/surgery , Appendix/pathology , Outcome and Process Assessment, Health Care , Appendectomy/adverse effects , Appendectomy/methods , Appendectomy/statistics & numerical data , Appendicitis/diagnosis , Appendicitis/physiopathology , Appendicitis/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Postoperative Complications/epidemiology , Spain/epidemiology , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Laparoscopy/adverse effects , Laparoscopy/methods , Laparoscopy/statistics & numerical data , Operative Time , Intraoperative Complications/epidemiology
10.
Rev. bras. cir. plást ; 34(1): 23-40, jan.-mar. 2019. ilus, tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-994538

ABSTRACT

Introdução: A necessidade de oferecer resultados com maior definição nas abdominoplastias nos compele a evoluir tecnicamente. O objetivo deste trabalho é apresentar a técnica de plicatura em Crossbow com suas três variantes, reforçando o conceito de aproximação vertical e horizontal da aponeurose dos músculos retos e oblíquos abdominais ao mesmo tempo, promovendo dois vetores diferentes de tração, culminando em uma maior definição da parede abdominal, principalmente na região do hipogastro e fossas ilíacas. Métodos: No período entre janeiro de 2016 e fevereiro de 2018, foram realizadas 22 cirurgias exclusivamente com a técnica Crossbow em seus tipos l, ll e lll, tanto em pacientes estéticos como pós-bariátricos. Resultados: Os resultados foram favoráveis tanto do ponto de vista estético, com maior definição do hipogastro, como do ponto de vista clínico, uma vez que nenhum paciente apresentou sinais ou sintomas diferentes de técnicas convencionais. Conclusão: A técnica Crossbow é simples e reprodutível, sendo mais um agregante na armamentária para melhorar a estética abdominal. Apesar de promover o reforço da região hipogástrica, tanto para tratamento primário como secundário desta região, só o aumento da casuística poderá demonstrar as possíveis vantagens do método.


Introduction: Owing to the need to deliver results with greater definition in abdominoplasties, techniques must evolve. The objective of this study was to introduce the crossbow technique for plication along with its three variants that reinforces the concept of vertical and horizontal alignments of the aponeurosis of the rectus and oblique abdominis muscles at the same time, promotes 2 different traction vectors, and culminates in a greater definition of the abdominal wall, mainly in the hypogastrium and iliac fossa regions. Methods: From January 2016 to February 2018, 22 surgeries were performed exclusively with the types l, ll, or lll crossbow technique, both in esthetic surgery cases and post-bariatric patients. Results: The results were favorable both from the esthetic point of view, with greater definition of the hypogastrium, and from a clinical point of view, as none of the patients showed signs or symptoms different from those of the conventional techniques. Conclusion: The crossbow technique is a simple and reproducible tool in the medical armamentarium to improve abdominal esthetics. Although it promotes the strengthening of the hypogastric region, both for primary and secondary treatments of this region, only a sample size increase can demonstrate the possible advantages of the method.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Postoperative Complications/prevention & control , Abdominal Muscles/surgery , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods , Abdominal Wall/abnormalities , Abdominal Wall/surgery , Aponeurosis/abnormalities , Aponeurosis/surgery
11.
Acta cir. bras ; 34(1): e20190010000009, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-983686

ABSTRACT

Abstract Purpose: To evaluate the contribution of ursodeoxycholic acid (UDCA) in the first 12 months after Roux-en-Y gastric bypass in the prevention of gallstone formation. Methods: A community-based clinical trial was conducted. A total of 137 patients were included in the study; 69 were treated with UDCA, starting 30 days after the surgery, at a dose of 150 mg twice daily (300 mg/day) over a period of 5 consecutive months (GROUP A), and 68 were control patients (GROUP B). The patients were followed-up, and ultrasonography was performed to determine the presence of gallstones at various times during follow-up. Demographic, anthropometric and comorbid indicators were obtained. The data were subjected to normality tests and evaluated using appropriate tests. Results: Patients did not differ in their baseline characteristics. Of the 69 patients who used UDCA, only one patient developed cholelithiasis (1%), whereas 18 controls (26%) formed gallstones (OR = 24.4, p <0.001). Also, other factors were found not to influence the formation of calculi, such as pre-operative or postoperative hepatic steatosis or diabetes (p = 0.759, 0.468, 0.956). Conclusion: The results demonstrated that patients who did not use UDCA showed a 24.4-fold greater probability of developing cholelithiasis.


Subject(s)
Humans , Male , Female , Adult , Postoperative Complications/prevention & control , Ursodeoxycholic Acid/therapeutic use , Obesity, Morbid/surgery , Cholagogues and Choleretics/therapeutic use , Gastric Bypass/adverse effects , Gallstones/prevention & control , Postoperative Complications/etiology , Postoperative Complications/drug therapy , Postoperative Period , Stomach/surgery , Gallstones/etiology , Gallstones/drug therapy , Comorbidity , Anthropometry , Prospective Studies
12.
Acta cir. bras ; 34(7): e201900703, 2019. tab, graf
Article in English | LILACS (Americas) | ID: biblio-1038114

ABSTRACT

Abstract Purpose: To compare four types of mesh regarding visceral adhesions, inflammatory response and incorporation. Methods: Sixty Wistar rats were divided into four groups, with different meshes implanted intraperitoneally: polytetrafluoroethylene (ePTFE group); polypropylene with polydioxanone and oxidized cellulose (PCD); polypropylene (PM) and polypropylene with silicone (PMS). The variables analyzed were: area covered by adhesions, incorporation of the mesh and inflammatory reaction (evaluated histologically and by COX2 immunochemistry). Results: The PMS group had the lowest adhesion area (63.1%) and grade 1 adhesions. The ePTFE and PM groups presented almost the total area of their surface covered by adherences (99.8% and 97.7% respectively) The group ePTFE had the highest percentage of area without incorporation (42%; p <0.001) with no difference between the other meshes. The PMS group had the best incorporation rate. And the histological analysis revealed that the inflammation scores were significantly different. Conclusions: The PM mesh had higher density of adherences, larger area of adherences, adherences to organs and percentage of incorporation. ePTFE had the higher area of adherences and lower incorporation. The PMS mesh performed best in the inflammation score, had a higher incorporation and lower area of adherences, and it was considered the best type of mesh.


Subject(s)
Animals , Male , Rats , Prostheses and Implants/adverse effects , Surgical Mesh/standards , Tissue Adhesions/pathology , Incisional Hernia/surgery , Inflammation/pathology , Polypropylenes/adverse effects , Polytetrafluoroethylene/adverse effects , Postoperative Complications/prevention & control , Silicones/adverse effects , Surgical Mesh/adverse effects , Materials Testing , Viscera/physiology , Cellulose, Oxidized/adverse effects , Tissue Adhesions/prevention & control , Rats, Wistar , Statistics, Nonparametric , Abdominal Wall
13.
Rev. gaúch. enferm ; 40(spe): e20180218, 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1004110

ABSTRACT

Resumo OBJETIVO Descrever a implantação do protocolo de termorregulação para procedimentos cirúrgicos em recém-nascido (RN). MÉTODOS Relato de experiência, realizado em uma unidade neonatal em Salvador-BA, no período de janeiro de 2016 a janeiro 2017. O ciclo Plan, Do, Check, Action norteou a construção, a implantação e a aplicabilidade do protocolo. RESULTADOS Implantação do protocolo que possibilitou a redução de eventos adversos por instabilidade térmica durante procedimentos cirúrgicos e introdução de novas tecnologias. CONCLUSÃO O protocolo possibilitou a melhoria e o fortalecimento das práticas assistenciais relacionadas com a cirurgia segura em RN.


Resumen OBJETIVO Describir la implementación del protocolo de termorregulación para procedimientos quirúrgicos en recién nacido (RN). MÉTODOS Relato de experiencia, realizado en una unidad neonatal en Salvador-BA, en el período de enero de 2016 a enero de 2017. El ciclo Plan, Do, Check, Action orientó la construcción, la implementación y la aplicabilidad del protocolo. RESULTADOS Se pudo implementar el protocolo que permitió reducir eventos adversos por inestabilidad térmica durante procedimientos quirúrgicos y se introdujo nuevas tecnologías. CONCLUSIÓN El protocolo permitió una mejora y un fortalecimiento de las prácticas asistenciales, relacionadas con la cirugía segura en RN.


Abstract OBJECTIVE To describe the thermoregulation protocol implementation for newborns (NB). METHODS An experimental report, conducted at a neonatal unit in Salvador, Bahia, from January 2016 to January 2017. The Plan, Do, Check, Action cycle guided the construction, implementation and applicability of the protocol. RESULTS Implementation of the protocol that allowed the reduction of adverse events due to thermal instability during surgical procedures and introduction of new technologies. CONCLUSION The protocol could improve and strengthen the care practices related to safe surgery in newborns.


Subject(s)
Humans , Infant, Newborn , Postoperative Complications/prevention & control , Surgical Procedures, Operative , Clinical Protocols , Perioperative Care/methods , Fever/prevention & control , Hypothermia/prevention & control , Intraoperative Complications/prevention & control , Practice Guidelines as Topic
14.
Rev. Col. Bras. Cir ; 46(5): e20192267, 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1057167

ABSTRACT

RESUMO Várias doenças da cavidade abdominal têm, na abordagem cirúrgica, sua principal forma de tratamento. Entretanto, o próprio procedimento cirúrgico é um agente estressor que pode promover efeitos adversos não relacionados com o objetivo do tratamento. A pré-habilitação emergiu como um programa multifatorial de condicionamento de saúde pré-operatório, que promove melhora na capacidade funcional e na evolução pós-operatória. O presente estudo faz uma revisão da literatura usando os bancos de dado MEDLINE, Ovid, Google Scholar e Cochrane para determinar o conceito, as indicações, os meios de seleção dos pacientes, e para sugerir as formas de implementação do programa de pré-habilitação em cirurgias abdominais de grande porte.


ABSTRACT Surgical approach is the main form of treatment for several diseases of the abdominal cavity. However, surgical procedure itself is a stressor that may lead to adverse effects unrelated to the treatment goal. Prehabilitation has emerged as a multifactorial preoperative health conditioning program, which promotes improvement in functional capacity and postoperative evolution. The present study reviews literature using MEDLINE, Ovid, Google Scholar, and Cochrane databases in order to determine the concept of prehabilitation program and the indications and means of patient selection for it, as well as to suggest ways to implement this program in cases of major abdominal surgeries.


Subject(s)
Humans , Male , Female , Postoperative Complications/prevention & control , Preoperative Care/methods , Elective Surgical Procedures/psychology , Abdomen/surgery , Postoperative Period , Psychotherapy , Preoperative Care/psychology , Exercise , Risk Factors , Nutritional Support , Recovery of Function
15.
Rev. Col. Bras. Cir ; 46(2): e2075, 2019. tab, graf
Article in Portuguese | LILACS (Americas) | ID: biblio-1003083

ABSTRACT

RESUMO A artroplastia total do joelho é um procedimento eletivo, realizado em indivíduos relativamente saudáveis. Porém, devido ao risco inerente de tromboembolismo venoso, são utilizados fármacos para sua profilaxia. O objetivo do presente trabalho foi conduzir uma revisão sistemática da literatura para comparar a eficácia da enoxaparina e da rivaroxabana na prevenção desta complicação e no risco de sangramento intraoperatório. Foi feita uma revisão no site SciELO, Pubmed e Cochrane através dos descritores, artroplastia de joelho, rivaroxabana e enoxaparina através da estratégia de busca PICO. Os critérios de inclusão foram os artigos no período estudado, que comparavam ambas as drogas em cirurgias de artroplastia do joelho. Os critérios de relevância para tornar o estudo elegível foram definidos como: somente artigos publicados a partir 2010 e com casuística com mais de 20 pacientes foram considerados; somente estudos obtidos em sua íntegra foram analisados; somente estudos com seguimento maior do que 12 meses foram considerados relevantes. As variáveis utilizadas para a comparação dos artigos foram as complicações mais comuns no pós-operatório de artroplastias do joelho: tromboembolismo venoso e sangramento. Foi utilizado o Review Man 5.3 para estruturação da revisão. Os autores observaram que nos estudos analisados, considerando tromboembolismo venoso sintomático, a rivaroxabana resultou em maiores benefícios quando comparada com a enoxaparina.


ABSTRACT Total knee arthroplasty is an elective procedure performed on relatively healthy individuals. However, due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. The objective of the present study was to conduct a systematic review of the literature to compare the efficacy of enoxaparin and rivaroxaban in preventing this complication and the risk of intraoperative bleeding. We reviewed the SciELO, Pubmed and Cochrane databases with the descriptors knee arthroplasty, rivaroxaban and enoxaparin through the PICO search strategy. Inclusion criteria were the articles during the study period comparing both drugs in knee arthroplasty. Relevant criteria to study eligibility were articles published since 2010 and with a sample of more than 20 patients; studies obtained in their entirety; and studies with follow-up of more than 12 months. The variables used to compare the articles were the most common postoperative complications of knee arthroplasties: venous thromboembolism and bleeding. We used the Review Man software, version 5.3, for structuring the review. In the studies analyzed, considering symptomatic venous thromboembolism, rivaroxaban resulted in higher benefits when compared to enoxaparin.


Subject(s)
Humans , Postoperative Complications/prevention & control , Enoxaparin/therapeutic use , Arthroplasty, Replacement, Knee/adverse effects , Venous Thromboembolism/prevention & control , Rivaroxaban/therapeutic use , Anticoagulants/therapeutic use , Postoperative Complications/ethnology , Risk Factors , Blood Loss, Surgical , Treatment Outcome , Postoperative Hemorrhage/chemically induced , Venous Thromboembolism/ethnology
16.
Acta cir. bras ; 33(9): 824-833, Sept. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-973497

ABSTRACT

Abstract Purpose: To evaluate the effects of hyperbaric oxygenation on prevention of adhesions in the abdominal cavity after laparotomy. Methods: Fifty four rats underwent laparotomy; stitches were made in the four quadrant parietal peritoneum and abdominal cavity closure. Animals were divided into three groups: 1 - control; 2 - subjected to high pressures and oxygenation; 3 - subjected to 100% hyperbaric oxygenation. The animals in groups 2 and 3 were daily submitted to oxygenation hyperbaric chamber after surgery. On the seventh day another laparotomy, registration of procedure, assessment of adhesions and biopsies of the peritoneum were held. Professionals analyzed the videos and the biopsies. Results: Peritoneal cavity adhesions occurred in animals of three groups with no difference between them. In Group 3, the adhesions presented more fragile and vascular proliferation more pronounced, and there was no difference in comparison with the first and second groups. However, there was no significant difference in the evaluation of these parameters between the animals in groups 1 and 2. Conclusions: Postoperative hyperbaric oxygenation in rats submitted to laparotomy did not alter the frequency, but reduced the density of adhesions in the peritoneal cavity and promoted vascular proliferation. The change in atmospheric pressure alone had no influence on the results.


Subject(s)
Animals , Rats , Peritoneal Cavity/surgery , Postoperative Complications/prevention & control , Tissue Adhesions/prevention & control , Hyperbaric Oxygenation/methods , Peritoneal Cavity/pathology , Rats, Wistar , Disease Models, Animal , Laparotomy
17.
Braz. j. microbiol ; 49(3): 552-558, July-Sept. 2018. tab, graf
Article in English | LILACS (Americas) | ID: biblio-951796

ABSTRACT

Abstract Surveillances and interventions on antibiotics use have been suggested to improve serious drug-resistance worldwide. Since 2007, our hospital have proposed many measures for regulating surgical prophylactic antibiotics (carbapenems, third gen. cephalosporins, vancomycin, etc.) prescribing practices, like formulary restriction or replacement for surgical prophylactic antibiotics and timely feedback. To assess the impacts on drug-resistance after interventions, we enrolled infected patients in 2006 (pre-intervention period) and 2014 (post-intervention period) in a tertiary hospital in Shanghai. Proportions of targeted pathogens were analyzed: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), imipenem-resistant Escherichia coli (IREC), imipenem-resistant Klebsiella pneumoniae (IRKP), imipenem-resistant Acinetobacter baumannii (IRAB) and imipenem-resistant Pseudomonas aeruginosa (IRPA) isolates. Rates of them were estimated and compared between Surgical Department, ICU and Internal Department during two periods. The total proportions of targeted isolates in Surgical Department (62.44%, 2006; 64.09%, 2014) were more than those in ICU (46.13%, 2006; 50.99%, 2014) and in Internal Department (44.54%, 2006; 51.20%, 2014). Only MRSA has decreased significantly (80.48%, 2006; 55.97%, 2014) (p < 0.0001). The percentages of VRE and IREC in 3 departments were all <15%, and the slightest change were also both observed in Surgical Department (VRE: 0.76%, 2006; 2.03%, 2014) (IREC: 2.69%, 2006; 2.63%, 2014). The interventions on surgical prophylactic antibiotics can be effective for improving resistance; antimicrobial stewardship must be combined with infection control practices.


Subject(s)
Humans , Postoperative Complications/microbiology , Bacteria/drug effects , Bacterial Infections/microbiology , Cross Infection/microbiology , Anti-Bacterial Agents/administration & dosage , Postoperative Complications/prevention & control , Bacteria/isolation & purification , Bacteria/growth & development , Bacterial Infections/prevention & control , Preoperative Care , Drug Resistance , Microbial Sensitivity Tests , China , Cross Infection/prevention & control , Antibiotic Prophylaxis
19.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(1): 5-11, mar. 2018. graf, tab
Article in Spanish | LILACS (Americas) | ID: biblio-896283

ABSTRACT

Introducción: El reemplazo total de rodilla es un procedimiento que puede generar una gran perdida de sangre durante el periodo posoperatorio. El acido tranexamico es un agente sintetico antifbrinolitico que, en los ultimos anos, se ha administrado por via intravenosa, con buenos resultados, al reducir el sangrado asociado al reemplazo total de rodilla. Sin embargo, existe escasa experiencia con su uso topico. Materiales y Métodos: Se llevo a cabo un estudio comparativo retrospectivo de 117 reemplazos totales de rodilla primarios, para comparar los resultados obtenidos en 63 cirugias con el uso topico de acido tranexamico y en 54 reemplazos sin acido tranexamico. Se compararon la tasa de transfusion, las concentraciones de hemoglobina y hematocrito a las 24 y 48 h, las curaciones requeridas, las comorbilidades y las complicaciones. Resultados: En el grupo con acido tranexamico topico, se redujo un 43,9% la tasa de transfusiones cuando se lo comparo con el otro grupo. Ademas, se registro una disminucion de 0,2-1,3 g/dl en la caida de la hemoglobina a las 24 h de la cirugia. No se detectaron complicaciones. Conclusiones: El uso topico de acido tranexamico en reemplazos totales primarios de rodilla disminuye los requerimientos de transfusiones, sin incrementar el riesgo de complicaciones. Nivel de Evidencia: III


Introduction: Total knee replacement is associated with extensive postoperative blood loss. Tranexamic acid is a synthetic antifibrinolytic agent that, in the last few years, has been successfully used intravenously to reduce bleeding after total knee replacement. However, topical application of tranexamic acid in total knee replacement remains largely unexplored. Methods: A retrospective study of 117 primary total knee replacements was conducted: 63 surgeries with topical tranexamic acid and 54 replacements without tranexamic acid. A comparison analysis was made, capturing results of blood transfusion rates, postoperative hemoglobin levels (24 and 48 hours), number of changed bandages, comorbidities and complications. Results: Tranexamic acid reduced blood transfusion rate by 43.9% when compared with the group without tranexamic acid. A lower decline in postoperative hemoglobin levels (24 hours) by 0.2-1.3 g/dL was also observed in this same group. There were no complications in both groups. Conclusions: Topically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement, without additional adverse effects. Level of Evidence: III


Subject(s)
Adult , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications/prevention & control , Tranexamic Acid/therapeutic use , Blood Loss, Surgical/prevention & control , Arthroplasty, Replacement, Knee/methods , Antifibrinolytic Agents/administration & dosage , Retrospective Studies , Administration, Topical , Treatment Outcome
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