Relationship between learning styles and simulation in surgery / Relação entre os estilos de aprendizagem e simulação em cirurgia

Abstract: Introduction: It was found that the good performance in conventional techniques was not transferable to minimally-invasive alternatives, and then simulators were created for improved learning. Objective: To assess whether robotic virtual reality simulation conditions ability for laparoscopy in medical students, associating the VARK tool and Mind Styles to determine whether there is a correlation between learning styles and the ability to develop these skills. Methods: Randomization of 3 groups of medical students was performed, where one of the groups performed a simulation of a surgical knot exercise in the laparoscopy box and another, the same exercise on the robot console. The third group did not simulate. All participants took a practical test in the laparoscopy box and their performances were evaluated. Moreover, a pre-test and a post-test were applied, in addition to the VARK and mind styles methods, to assess whether there was a difference in performance between the different learning styles. Results: The practical test scores were relatively homogeneous between the groups and between the Mind Styles and VARK categories, with no significant difference being found between the groups; therefore, it was not possible to demonstrate that learning styles interfered with the results of this study. There was only a significant difference between the pre-test scores of at least one pair of the groups and between the Laparoscopy and Robotics groups, with a p-value of 0.038. Conclusion: There was no statistical significance between learning styles and performance regarding the proposed tasks.

Resumo: Introdução: Constatou-se que o bom desempenho em técnicas convencionais não se transferia para as minimamente invasivas, e, com isso, foram criados os simuladores para melhor aprendizado. Objetivo: Este estudo teve como objetivo avaliar se a simulação em realidade virtual robótica promove habilidade para laparoscopia em acadêmicos de Medicina, associando a ferramenta VARK e o mind styles (GSD) para determinar se há correlação dos estilos de aprendizagem com a capacidade de desenvolver essas habilidades. Método: Realizou-se randomização de três grupos de acadêmicos de Medicina, em que um dos grupos fez simulação de um exercício de nó cirúrgico na caixa de laparoscopia (CL), e outro, o mesmo exercício no console do robô. O terceiro grupo não participou da simulção. Todos os participantes fizeram um teste prático na CL, e as performances deles foram avaliadas. Ademais, foram aplicados um pré-teste e um pós-teste, além do formulário VARK e GSD, para avaliar se havia diferença de performance entre os diferentes estilos de aprendizagem. Resultado: As notas das provas práticas foram relativamente homogêneas entre grupos e entre as categorias de Mind Styles e do VARK. Como não se encontrou diferença significativa entre os grupos, não foi possível demonstrar que os estilos de aprendizagem interferiram nos resultados deste estudo. Houve apenas diferença significativa entre as notas do pré-teste de pelo menos um par de grupos e entre os grupos laparoscopia e robótica com p-valor 0,038. Conclusão: Não houve significância estatística entre os estilos de aprendizagem e o desempenho nas tarefas propostas.

O impacto do uso de aplicativos na aderência e persistência ao tratamento de incontinência urinária feminina: estudo longitudinal randomizado / Impact of app use on adherence and persistence to the treatment of female urinary incontinence: randomized longitudinal study

Objetivo: Analisar a adesão de mulheres incontinentes à fisioterapia pélvica auxiliada por smartphone (aplicativo), em comparação a abordagens tradicionais. Métodos: Estudo longitudinal randomizado controlado de 128 mulheres: G1 fisioterapia face a face auxiliada por aplicativo; G2 fisioterapia face a face e folha de exercícios impressa; G3 aplicativo somente e G4 folha impressa somente. Realizadas 12 sessões de fisioterapia face a face, em grupo, uma vez por semana, durante 3 meses. Resultados: 77 (60,2%) aderiram ao tratamento e 51 (39,8%) não. Os aderentes tinham em média 48,3 anos, contra 44,5 das não aderentes (p = 0,015). Houve menor adesão às metodologias síncronas: G1, 19 (50%), G2, 21 (28,8%), quando comparadas às assíncronas: G3, 3 (13,6%), e no G4, 8 (32%) (p = 0,025). Fumantes (71,4%) e usuárias de álcool (53,85%) não aderiram (p = 0,002 e p = 0,016 respectivamente). 50 mulheres apresentaram IU de esforço, 67 IU mista e 11 IU de urgência, não correlacionada à adesão (p = 0,06). Nenhuma das mulheres não aderentes possuiu renda superior a 6 salários-mínimos. Conclusão: A adesão ao treinamento muscular do assoalho pélvico é maior quando a fisioterapia é associada a um aplicativo móvel. O tabagismo, o consumo de álcool e a categoria de renda impactam negativamente na adesão.

Evaluation of nefrotoxicity by tacrolimus and micophenolate mofetil associated with kidney ischemia and reperfusion: experimental study in rats / Avaliação da nefrotoxicidade pelo tacrolimus e micofenolato mofetil associados à isquemia e reperfusão renal: estudo experimental em ratos

ABSTRACT Objective: to evaluate the renal toxicity caused by tacrolimus and mycophenolate mofetil (MMF) in a single kidney ischemia and reperfusion model. Method: experimental study using Wistar rats, submitted to right nephrectomy and left renal ischemia for 20 minutes, separated into groups in the postoperative period (PO): 1) Control (nonoperated); 2) Sham (operated, without PO drug); 3) TAC0.1, TAC1 and TAC10, tacrolimus administered PO at doses of 0.1mg/kg, 1mg/kg and 10mg/kg via gavage, respectively; 4) MMF, administered mycophenolate mofetil 20mg/kg; 5) MMF/TAC1 and MMF/TAC0.5, with an association of mycophenolate mofetil 20mg/kg and tacrolimus 1mg/kg and 0.5mg/kg, respectively. They were killed on the 14th PO and the kidney was removed for tissue oxidative stress analysis, by the dosage of reduced glutathione (GSH), lipoperoxidation (LPO) and protein carbonylation (PCO), and histological analysis by glomerular stereology (Glomerular volume density, Numerical density glomerular and mean glomerular volume). Renal function was evaluated by the measurement of serum creatinine and urea. Results: both drugs caused alterations in renal function, and the toxicity of tacrolimus was dose-dependent. Subacute toxicity did not show significant glomerular histological changes, and there was renal and compensatory glomerular hypertrophy in all groups except TAC10. Conclusion: Both drugs cause changes in renal function. Glomerular morphometry and stereology showed negative interference of immunosuppressants during compensatory glomerular hypertrophy.

RESUMO Objetivo: avaliar a toxicidade renal causada pelo tacrolimus e micofenolato mofetil (MMF) em um modelo de isquemia e reperfusão de rim único. Método: estudo experimental utilizando ratos Wistar, submetidos á nefrectomia direita e isquemia renal esquerda por 20 minutos, separados em grupos no pós- operatório (PO): 1) Controle (não operados); 2) Sham (operados, sem droga PO); 3) TAC0.1, TAC1 e TAC10, administrado tacrolimus no PO nas doses 0,1mg/kg, 1mg/kg e 10mg/kg via gavagem, respectivamentae; 4) MMF, administrado micofenolato mofetil 20mg/kg; 5) MMF/TAC1 e MMF/TAC0.5, com associação de micofenolato mofetil 20mg/kg e tacrolimus 1mg/kg e 0,5mg/kg, respectivamente. Foram mortos no 14º PO e retirado rim para análise do estresse oxidativo tecidual, pela dosagem de glutationa reduzida (GSH), lipoperoxidação (LPO) e carbonilação de proteínas (PCO), e análise histológica por estereologia glomerular (Densidade de volume glomerular, Densidade numérica glomerular e Volume glomerular médio). Foi avaliada função renal pela dosagem de creatinina e uréia séricas. Resultados: ambas drogas provocaram alteração na função renal, sendo a toxicidade do tacrolimus dosedependente. A toxicidade subaguda não mostrou alterações histológicas glomerulares significativas, sendo que houve hipertrofia renal e glomerular compensatória em todos os grupos exceto em TAC10. Conclusão: Ambas drogas provocam alteração na função renal. A morfometria e a estereologia glomerular mostraram interferência negativa dos imunossupressores durante a hipertrofia glomerular compensatória..

Stereological study and analysis of oxidative stress during renal aging in rats

Purpose To evaluate renal histological changes by stereology and morphometry and analyze the main markers of oxidative stress in rats undergoing natural aging. Methods Seventy two Wistar rats were divided into six groups of 12 rats each, which were euthanized at 3, 6, 9, 12, 18, and 24 months of age. Right kidney was stereologically and morphometrically analyzed to calculate the volumetric density (Vv[glom]), numerical density (Nv[glom]) and glomerular volume (Vol[glom]). Left kidney was used to determine the levels of nonprotein thiols, lipid peroxidation, and protein carbonylation, as well as the activities of superoxide-dismutase and catalase enzymes. Results Both Vv[glom] and Nv[glom] values showed gradual decreases between groups. Activity of superoxide-dismutase was elevated at 24 months of age, and the levels of nonprotein thiols were higher in older animals. Greater catalase activity and protein carbonylation were observed in animals between 6 and 12 months of age but lessened in older rats. Lipid peroxidation decreased in the older groups. Conclusions Morphometric and stereological analyses revealed a gradual decrease in the volume and density of renal glomeruli during aging, as well as kidney atrophy. These findings related to oxidative stress clarify many changes occurring in kidney tissues during senescence in rats.

Stereological study and analysis of oxidative stress during renal aging in rats

Abstract Purpose To evaluate renal histological changes by stereology and morphometry and analyze the main markers of oxidative stress in rats undergoing natural aging. Methods Seventy two Wistar rats were divided into six groups of 12 rats each, which were euthanized at 3, 6, 9, 12, 18, and 24 months of age. Right kidney was stereologically and morphometrically analyzed to calculate the volumetric density (Vv[glom]), numerical density (Nv[glom]) and glomerular volume (Vol[glom]). Left kidney was used to determine the levels of nonprotein thiols, lipid peroxidation, and protein carbonylation, as well as the activities of superoxide-dismutase and catalase enzymes. Results Both Vv[glom] and Nv[glom] values showed gradual decreases between groups. Activity of superoxide-dismutase was elevated at 24 months of age, and the levels of nonprotein thiols were higher in older animals. Greater catalase activity and protein carbonylation were observed in animals between 6 and 12 months of age but lessened in older rats. Lipid peroxidation decreased in the older groups. Conclusions Morphometric and stereological analyses revealed a gradual decrease in the volume and density of renal glomeruli during aging, as well as kidney atrophy. These findings related to oxidative stress clarify many changes occurring in kidney tissues during senescence in rats.

Learning Preferences and Multiple Intelligences: An Observational Study in Brazilian Studies / Preferências de Aprendizagem e Inteligencias Múltiplas: Um Estudo Observacional em Estudantes Brasileiros

ABSTRACT In recent years, Multiple Intelligences (MI - bodily-kinesthetic, spatial, intrapersonal, interpersonal, linguistic, logical-mathematical, musical, and naturalist) and Learning Preferences (LP - visual, aural, read/write, kinesthetic, and multimodal) have been intensely studied throughout the world. In this context, plenty of tools that evaluate such parameters have been created and later improved over the past decades. Nowadays, the necessity for optimal learning strategies and more individualized teaching continues to rise, reinforcing the importance of identifying individual strengths and cognitive preferences. Objectives to analyze the distribution of MI - and how they influence one another - and LP in medical students at the Federal University of Paraná (UFPR), Brazil. The results could lead to improvements in the educational setting. Methods a descriptive cross-sectional study involving UFPR medical students of all 12 semesters, who were analyzed through questionnaires with regard to both their MI ("Multiple Intelligences Checklist for Students") and LP ("Visual, Aural, Read/Write, Kinesthetic - VARK - Questionnaire"). Results a total of 1054 questionnaires were processed (527 students). Intrapersonal (71 ± 10.5), logical-mathematical (69.3 ± 14), and linguistic (68.4 ± 11.8) intelligences predominated, whereas naturalist achieved the lowest mean score (47.3 ± 19.5). Positive correlations were identified between all of the MI. Regarding the LP, the multimodal (42.3%) was the most frequent, followed by visual (21.3%), aural (18.6%), kinesthetic (11.2%), and read/write (6.6%). When both cognitive theories were correlated, the following associations prevailed: visual LP and intrapersonal intelligence; aural LP and interpersonal intelligence; read/write LP and logical-mathematical intelligence; kinesthetic LP and logical-mathematical intelligence; and multimodal preference and intrapersonal intelligence. Conclusions intrapersonal intelligence achieved the highest overall scores, followed by logical-mathematical and linguistic. Naturalist intelligence achieved the lowest scores in terms of semester, cycle, and overall analysis. All MI were positively correlated. Multimodality was the most commonly observed LP, whereas the read/write preference was the least frequent. Correlations initially expected between MI and LP were confirmed. As for future perspectives, it is expected that teachers and education managers adapt current teaching strategies in order to meet the students' preferences. Together, MI and LP indicate that the focus should not rely on how smart a given person is, but in which ways.

RESUMO Nos últimos anos, Inteligências Múltiplas (IM - corporal-cinestésica, espacial, intrapessoal, interpessoal, linguística, lógico-matemática, musical e naturalista) e Preferências de Aprendizagem (PA - visual, auditiva, leitura/escrita, cinestésica, multimodal) vêm sendo intensamente estudadas em todo o mundo. Em tal contexto, diversas ferramentas que avaliassem tais parâmetros foram criadas e posteriormente aprimoradas ao longo das últimas décadas. Atualmente, a necessidade de se utilizar as melhores estratégias de aprendizado e a crescente necessidade de que o ensino seja individualizado reforçam a importância de que sejam mapeadas as habilidades e preferências cognitivas individuais. Objetivos analisar as distribuições de IM - e como elas se influenciam - e das PA em estudantes de medicina da Universidade Federal do Paraná (UFPR), Brasil. Espera-se que os resultados estimulem melhorias no contexto educacional. Materiais e Métodos estudo transversal e descritivo envolvendo estudantes de medicina da UFPR de todos os 12 semestres, sendo analisados através de questionários quanto às suas MI e ("Lista de verificação para avaliar inteligências múltiplas de alunos") e PA ("Visual, Aural, Read/Write, Kinesthetic - VARK - Questionnaire", previamente traduzido e validado para a língua Portuguesa). Resultados 1054 questionários foram coletados e processados. As IM intrapessoal (71±10,5), lógico-matemática (69,3±14) e linguística (68,4±11,8) atingiram as maiores médias gerais, enquanto a naturalista registrou a menor pontuação (47,3±19,5). Observou-se correlação positiva entre todas as IM. Quanto às PA, prevaleceu a multimodal (42,3%), seguida por visual (21,3%), auditiva (18,6%), cinestésica (11,2%) e leitura/escrita (6,6%). Quando correlacionadas ambas as teorias cognitivas, sobressaíram-se as seguintes associações: PA visual e IM intrapessoal; PA auditiva e IM interpessoal; PA leitura/escrita e IM lógico-matemática; PA cinestésica e IM lógico-matemática; e PA multimodal e IM intrapessoal. Conclusão A IM intrapessoal atingiu maiores médias, seguida por lógico-matemática e linguística. A IM naturalista, por outro lado, obteve menores pontuações em termos de semestres, ciclos e análise geral. Todas as inteligências apresentaram influência apresentaram interdependência positiva. A multimodalidade foi a PA mais prevalente, enquanto leitura/escrita foi a menos observada. Correlações inicialmente esperadas entre IM e PA foram confirmadas. Quanto às perspectivas futuras, espera-se que professores e gestores educacionais adaptem estratégias de ensino atuais de modo a melhor contemplar as preferências dos estudantes. Em conjunto, IM e PA preconizam que atualmente não mais se questione o quão inteligente alguém seja, e sim de que maneiras o seria.

Stereological analysis of elastic fibers of the corpus cavernosum of rats during the aging process

Abstract Purpose To evaluate changes in the quantity of elastic fibers in the corpora cavernosa of rats during the natural aging process, and to assess the degree of this change by determining volumetric density (Vv) at different ages via stereological analysis. Methods Forty-eight rats, raised under similar conditions, were subjected to the natural aging process and divided into four groups (G1 to G4), according to age at the time of penectomy (6, 9, 12, and 24 months, respectively). Histological sections of the middle segment of the penis were stained with Weigert's resorcin-fuchsin, and the volumetric density (Vv) of elastic fibers of the corpora cavernosa were determined via stereological analysis. Results There were no statistically significant differences in Vv among groups G1, G2, and G3. These three groups were therefore considered as a single group. The mean Vv of this group showed a statistically significant reduction compared to that of G4 (0.16 vs. 0.11, p<0.05). Conclusion Natural aging in rats was responsible for a reduction in volumetric density of elastic fibers of the corpora cavernosa (approximately 30% decrease in Vv) during senescence.

Stereological and morphological analysis of the effects of aging on spermatogenesis in rat testis

Abstract Purpose: To quantify, through stereological and morphometric analysis, spermatogenesis in rats undergoing the natural aging process. Methods: Seventy-two male Wistar rats were divided into 6 equal groups according to age at the time of killing: 3, 6, 9, 12, 18, and 24 months. All the rats were subjected orchiectomy and collection of testicular parenchymal fragments for histological and morphometric analysis. The numerical density of spermatids was calculated using a stereological study, and morphometric analysis was conducted to measure the height of the germinal epithelium and the area of the seminiferous tubules. Results: We found that the 18 and 24 months groups showed a significant reduction in the number of round spermatids. However, the height of the germinal epithelium was not significantly different between the groups. The area of seminiferous tubules was also significantly reduced in the elderly rats compared to that in the young ones. Conclusion: Aging of rats showed a significant reduction in the number of round spermatids and the area of the seminiferous tubules, more pronounced in the rats at 18 and 24 months of life.

Numeric and volumetric changes in Leydig cells during aging of rats

Abstract Purpose: To analyze the effects of aging in rats on the nuclear volume, cytoplasmic volume, and total volume of Leydig cells, as well as their number. Methods: Seventy-two Wistar rats were divided into six subgroups of 12 rats, which underwent right orchiectomy at 3, 6, 9, 12, 18, and 24 months of age. The weight and volume of the resected testicles were assessed. A stereological study of Leydig cells was conducted, which included measurements of cell number and nuclear, cytoplasmic, and total cell volumes. Results: The weight and volume of the resected testicles showed reductions with age. Only the subgroup composed of 24-month old rats showed a decrease in the nuclear volume of Leydig cells. Significant reductions in the cytoplasmic volume and total volume of Leydig cells were observed in 18- and 24-month old rats. The number of Leydig cells did not vary significantly with age. Conclusions: Aging in rats resulted in reduction of the nuclear, cytoplasmic, and total cell volumes of Leydig cells. There was no change in the total number of these cells during aging.

Quantitative analysis of the renal aging in rats. Stereological study

ABSTRACT PURPOSE: To evaluate the renal function and the renal histological alterations through the stereology and morphometrics in rats submitted to the natural process of aging. METHODS: Seventy two Wistar rats, divided in six groups. Each group was sacrificed in a different age: 3, 6, 9, 12, 18 and 24 months. It was performed right nephrectomy, stereological and morphometric analysis of the renal tissue (renal volume and weight, density of volume (Vv[glom]) and numerical density (Nv[glom]) of the renal glomeruli and average glomerular volume (Vol[glom])) and also it was evaluated the renal function for the dosage of serum creatinine and urea. RESULTS: There was significant decrease of the renal function in the oldest rats. The renal volume presented gradual increase during the development of the rats with the biggest values registered in the group of animals at 12 months of age and significant progressive decrease in older animals. Vv[glom] presented statistically significant gradual reduction between the groups and the Nv[glom] also decreased significantly. CONCLUSIONS: The renal function proved to be inferior in senile rats when compared to the young rats. The morphometric and stereological analysis evidenced renal atrophy, gradual reduction of the volume density and numerical density of the renal glomeruli associated to the aging process.

Objective assessment of surgical technique in rotation and nasal projection variation / Avaliação objetiva da técnica cirúrgica na variação da rotação e projeção nasal

ABSTRACT INTRODUCTION: In rhinoplasty, facial esthetic analysis is critical for proper surgical planning. Parameters such as rotation and nasal projection should be routinely evaluated. Few studies have objectively assessed changes in facial angles postoperatively. OBJECTIVE: To evaluate the effectiveness of medial intercrural sutures and of rotation of the nasal tip on the increase of rotation and nasal projection in Caucasian patients undergoing primary rhinoplasty. METHODS: A prospective study carried out between 2011 and 2013, with 27 patients treated with primary rhinoplasty with a basic technique by the same surgeon, with medial intercrural sutures and rotation of the nasal tip. Rotation and nasal projection were measured from photographs obtained preoperatively and after 12 months. RESULTS: All 27 patients completed the study. The mean age was 27.1 years. There was a mean increase of 8.4° in the rotation - a statistically significant value. There was no significant change in the projection. CONCLUSION: The medial intercrural and nasal tip rotation sutures are effective in increasing nasal rotation in Caucasian patients undergoing rhinoplasty.

RESUMO INTRODUÇÃO: Na rinoplastia, a análise estética facial é essencial para um planejamento cirúrgico adequado. Parâmetros como rotação e projeção nasal devem ser rotineiramente avaliados. Há poucos estudos que avaliem objetivamente as mudanças nos ângulos faciais no pós-operatório. OBJETIVO: Avaliar a eficácia das suturas intercrura mediais e de rotação da ponta nasal no aumento da rotação e projeção nasal em pacientes caucasianos submetidos à rinoplastia primária. MÉTODO: Estudo prospectivo realizado entre 2011 e 2013, com 27 pacientes submetidos à rinoplastia primária técnica básica, pelo mesmo cirurgião, com suturas intercrura mediais e de rotação da ponta nasal. Mediu-se a rotação e a projeção nasal a partir de fotografias no pré-operatório e 12 meses após. RESULTADOS: Todos os 27 pacientes completaram o estudo. A idade média foi de 27,1 anos. Houve aumento médio de 8,4° na rotação, com significância estatística. Não houve alteração significativa na projeção. CONCLUSÃO: As suturas intercrura mediais e de rotação da ponta nasal são eficazes no aumento da rotação nasal em pacientes caucasianos submetidos à rinoplastia.

Effects of immunosuppression with tacrolimus and mycophenolate mofetil on renal histology and function in single kidney rats submitted to ischemia and reperfusion

PURPOSE: To evaluate renal histological changes and renal function in single kidney rats submitted to renal ischemia-reperfusion and to immunosuppression with tacrolimus and mycophenolate-mofetil. METHODS: Experimental study with 80 Wistar rats distributed into control, Sham and six other groups treated with immunosuppressive drugs. Animals undergoing surgery, right nephrectomy and left renal clamping, killed on the 14th day and analyzed for renal histology, urea and creatinine. RESULTS: The group receiving tacrolimus at higher doses (T3) showed renal histological lesions indicative of early nephrotoxicity, and significant increase in urea and creatinine. The group M (mycophenolate-mofetil alone) and the group M2 (mycophenolate-mofetil combined with half the usual dose of tacrolimus) presented a slight rise in serum urea. The groups using mycophenolate-mofetil alone or combined with tacrolimus showed creatinine levels similar to that of the group T3. CONCLUSIONS: Histologically, the association of injury by ischemia-reperfusion with the use of tacrolimus or mycophenolate-mofetil alone demonstrated a higher rate of renal changes typical of early nephrotoxicity. In laboratory, the combination of injury by ischemia-reperfusion with tacrolimus at higher doses proved to be nephrotoxic. .

Analysis of the histology of the scar bladder and biochemical parameters of rats with a solitary kidney undergoing immunosuppression with tacrolimus

PURPOSE: To evaluate bladder histology in healing and biochemical analysis of rats with single kidney in ischemia/reperfusion, treated with tacrolimus. METHODS: Fifty rats randomized into five groups. Three rats died in surgery, 47 rats divided in groups: Control (non-operated, n=10), Sham (operated without drugs, n=8), T1 (operated + tacrolimus 1mg/kg, n=10), T2 (operated + tacrolimus 0.1 mg/kg, n=10), T3 (operated + tacrolimus 10mg/kg, n=9). The surgery was: laparotomy, right nephrectomy, left kidney ischemia/reperfusion, cystotomy followed by bladder suture. After that, rats were submited to gavage daily (Control and Sham with saline solution. T1, T2, T3 with tacrolimus in doses already mentioned). On the 14th day, after death induction, cystectomy was performed and bladder was histologicaly analysed. The serum urea, creatinine and tacrolimus were analysed too. RESULTS: There was difference in serum tacrolimus in T3 compared to the other groups (p<0.05). There was higher doses of creatinine in T3 group and higher urea in groups with tacrolimus. There were significant differences among all histologic variables comparing groups with and without tacrolimus (p<0.05). CONCLUSION: Tacrolimus associated with ischemia/reperfusion is nephrotoxic, suppresses inflammation and seems to delay the healing bladder. .

Modelo pélvico sintético como uma ferramenta didática efetiva comparada à pelve cadavérica / A synthetic three-dimensional pelvic model as an effective didactic tool compared to cadaveric pelvis

A anatomia é considerada matéria essencial à educação médica. Aulas práticas com uso de componentes anatômicos manipuláveis são fundamentais ao ensino e à aprendizagem. O objetivo deste estudo foi avaliar o Modelo Sintético de Pelve (Masp) como ferramenta didática, comparada à pelve cadavérica (PC) tradicionalmente utilizada, bem como a satisfação dos estudantes em relação a ambos os métodos. Sessenta e sete estudantes receberam aula teórica após teste teórico preliminar (TTP). Foram randomizados em três grupos: G1 teve aula prática tradicional (APT); G2, aula prática com Masp (APM); e G3 não teve aula prática. Um teste final (TTF) foi aplicado a todos os grupos. G1 e G2 submeteram-se à avaliação do método (AM). A análise estatística foi realizada utilizando-se Anova (Análise de Variância) e teste não paramétrico Mann-Whitney. No TTF, G3 apresentou escores mais baixos do que G1 (p = 0,041) e G2 (p = 0,000). Não foi encontrada diferença estatisticamente significante entre G1 e G2 (p >0,05). G2 apresentou maior satisfação com o método (p = 0,001). Concluiu-se que PC e Masp provaram ser ferramentas didáticas efetivas e que G2 mostrou maior satisfação.

Anatomy is considered a fundamental subject of medical education. Practical classes which involve the use of manipulable anatomic components are essential to teaching and learning. The aim of this study was to evaluate the synthetic pelvic model (SPM) as a didactic tool, compared to the traditionally- -used cadaveric pelvis (CP), as well as student satisfaction in relation to both methods. Sixty-seven students were given a theory class following the preliminary theoretical test (PTT). The study sample was randomized in three groups: G1 had a traditional practical class (TPC); G2 had a practical class with SPM (PCS); and G3 had no practical class. A final test (FTT) was applied to all the groups. G1 and G2 were subjected to method evaluation (ME). Statistical analysis was conducted using analysis of variance (ANOVA) and the Mann-Whitney U test. In the FTT, G3 presented scores lower than G1 (p = 0.041) and G2 (p = 0.000). No statistically significant difference was found between G1 and G2 (p >0.05). G2 presented greater satisfaction with the method (p = 0.001). In conclusion, both CP and SPM proved to be effective didactic tools and student satisfaction was greater with G2.

Dynamic evaluation of pelvic floor reconstructive surgery using radiopaque meshes and three-dimensional helical CT

PURPOSE: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. MATERIALS AND METHODS: A total of 30 female patients with stress urinary incontinence (SUI), anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. RESULTS: In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. CONCLUSION: Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.

Manejo no prolapso uterino / Uterine prolapse handling

Prolapso refere-se à queda ou saída de um lugar. Prolapso de órgão pélvico é a descida de um órgão pélvico pela vagina, freqüentemente acompanhada de sintomas urinários, sexuais, intestinais e locais. Os sintomas são avaliados e a investigação pode ser feita através de estudo urodinâmico ou imagem. O tratamento do prolapso genital pode ser conservador ou cirúrgico, dependendo das necessidades e condições da paciente

Safyreã: a readjustable minimally invasive sling for female urinary stress incontinence

INTRODUCTION: SAFIRE TM is a readjustable and minimally invasive sling for the treatment of stress urinary incontinence (SUI). It is as a pubovaginal sling placed in the medial third of the urethra. The initial experience is described. MATERIALS AND METHODS: Forty-five patients (mean age = 59 years) underwent a SAFYRE TM implant to treat SUI. Physical examination and urodynamic study were performed before surgery. All patients presented symptoms of SUI and 20 percent also reported mild urgency. Approximately 60 percent of this group had a previously failed anti-incontinence procedure. Urethral hypermobility was diagnosed in 40 percent of the patients and intrinsic sphincter deficiency (ISD) in 60 percent of the cases. RESULTS: The average follow up period was 10 months. The mean operative time was 20 minutes. Dystopia repair was performed whenever necessary, during the same procedure. The average hospital stay was 24 hours. In 11 percent of the implants, bladder perforation occurred. During the postoperative period, 9 patients (20 percent) developed transient urgency symptoms. During the initial follow up period, 90 percent were found to be continent, 3 percent reported an improvement and 7 percent were unchanged. CONCLUSION: SAFYRE TM is a safe and quick procedure that allows postoperative readjustment. This technique may be an attractive alternative in the management of SUI, should the good result obtained so far prove to be long lasting.

Gastroplastia vertical restritiva com derivaçäo gastrointestinal em Y de Roux em suínos: aspectos histopatológicos do segmento gástrico isolado / Restrictive vertical gastroplasty with Roux-en-Y gastrointestinal bypass in swines: histopathological aspects of the bypassed gastric segment

OBJETIVO: Estabelecer um modelo animal de gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux, avaliando alteraçöes na quantidade da ingesta, na perda de peso e os aspectos macroscópicos da mucosa e histopatológicos da parede do segmento gástrico isolado. MÉTODOS: Dezesseis suínos machos, foram alocados em dois grupos. O Grupo Cirurgia incluiu 8 animais submetidos a gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux. O Grupo Controle foi composto por 8 suínos intactos, submetidos ao mesmo cuidado e dieta. O Grupo Cirurgia foi observado por 90 dias, quando foi sacrificado para estudo do segmento gástrico isolado. O Grupo Controle foi observado por 84 dias, quando os animais foram sacrificados para ressecçäo gástrica. RESULTADOS: Foram avaliados a variaçäo ponderal e o volume da ingesta alimentar de ambos os grupos. Avaliou-se alteraçöes macroscópicas da mucosa, alteraçöes morfométricas das glândulas gástricas, características histopatológicas e quantidade de colágeno tipo I e III na camada mucosa no segmento gástrico isolado do Grupo Cirurgia. O peso dos animais e a ingesta alimentar foi significativamente maior no Grupo Controle que no Cirurgia. Ocorreu diminuiçäo no tamanho das glândulas gástricas, maior quantidade de colágeno tipo I na camada mucosa e deposiçäo de tecido gorduroso na camada muscular do segmento gástrico isolado. CONCLUSAO: O modelo suíno de gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux proporciona reduçäo da ingesta e perda ponderal. A gastroplastia restritiva com derivaçäo gastrointestinal em Y de Roux em suínos näo proporciona alteraçöes macroscópicas no segmento gástrico isolado e que os achados histopatológicos säo compatíveis com os de atrofia inicial do segmento gástrico isolado.