Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática / Evidence of the effectiveness of the use of presurgical orthopedic appliances in patients with cleft lip and palate: a systematic review

Resumen El objetivo de este artículo fue evaluar la evidencia sobre el uso de una aparatología ortopédica prequirúrgica (AOP) en pacientes con labio y paladar hendido. Se realizó una búsqueda en las siguientes bases de datos: Medline/PubMed, Google Scholar, Clinical Trails.gov, ProQuest y Web of Science. En la búsqueda, se encontraron 7.926 registros, de los cuales se analizaron 105 artículos de texto completo; de éstos se incluyeron 23 estudios en pacientes con uso de AOP, asi como su grupo control sin el uso del AOP, previo al mismo tipo de cirugía. Los aparatos más utilizados para la AOP en el manejo de LPH fueron: el paladar pasivo (Paladar de Hotz), el modelador nasolaveolar (NAM), aparato McNeil y por último el T-traction; los principales desenlaces evaluados fueron: la estética facial y apariencia nasal; la evaluación de medidas cefalométricas, de vías aéreas superiores, nasales, del ancho de la fisura y así como puntos de referencia anatómicos como la distancia inter-canina e inter-tuberosidad. Además, se encontraron estudios que evaluaron oclusión y la fonación. La evidencia de esta literatura sugiere que el uso de aparatos activos tiene un mejor efecto que la placa pasiva, en términos de estética facial y aproximación de los segmentos maxilares para el cierre de la fisura. Sin embargo, la heterogeneidad, el riesgo de sesgo y la baja calidad de los estudios no permite tener conclusiones sólidas.

Abstract This review article aimed to evaluate the evidence on the use of a presurgical orthopedic appliance (POP) in patients with cleft lip and palate. The search was conducted using Medline/PubMed, Scholar Google, Clinical Trails, ProQuest, Scopus, and Web of Science databases. During the search, 7,926 records were found, of which 105 full-text articles were analyzed, and 23 studies included analysis in patients with the use of POP, and their control groups without the use of POP prior to the same type of surgery. The devices most used for POP in the management of LPH were: the passive palate (Hotz palate), the nasolaveolar moulding (NAM), the McNeil device, and finally, the T-traction. The primary outcomes evaluated were: facial aesthetics and nasal appearance; the evaluation of cephalometric measurements, upper airways, nasal fissure width, as well as anatomical references such as inter-canine and intertuberosity distances. In addition, studies that evaluated occlusion and phonation were found. The evidence from this literature suggests that the use of active appliances had a better effect than passive appliances in terms of facial aesthetics and approximation of the maxillary segments for the closure of the fissure. However, the heterogeneity, the risk of bias, and the low quality of the studies do not allow to state firm conclusions.

Ortopedia prequirúrgica en el tratamiento de pacientes con fisura labio y paladar / Presurgical orthopedics in the treatment of patients with cleft lip and palate

RESUMEN: Introducción: Dentro del tratamiento estándar de los pacientes con fisura labio-máxilo-palatinas se encuentra la ortopedia prequirúrgica. Esta se realiza con el objetivo de modular la posición, alineación y estabilización de los segmentos maxilares previo a la primera cirugía. Pese a que es ampliamente utilizada, su efectividad es controversial. Métodos: Se realizó una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Se extrajeron los datos desde las revisiones identificadas, se analizaron los datos de los estudios primarios, posteriormente se realizó un metaanálisis y se preparó una tabla de resumen de los resultados utilizando el método GRADE. Resultados y Conclusiones: Se identificaron 14 revisiones sistemáticas que en conjunto incluyeron 57 estudios primarios, de los cuales, cinco corresponden a ensayos clínicos aleatorizados. Concluimos que no es posible establecer con claridad si la ortopedia prequirúrgica mejora o perjudica la morfología maxilar, debido a que la certeza de la evidencia ha sido evaluada como muy baja. Por su parte, la ortopedia prequirúrgica podría resultar en poca o nula diferencia en el crecimiento y desarrollo facial, las alteraciones oclusales, la satisfacción parental, la alimentación, el habla y la apariencia facial y nasolabial, pero la certeza de la evidencia es baja.

ABSTRACT: Introduction: Within the standard treatment of patients with labio-maxillo-palatal cleft is presurgical orthopedics. This procedure seeks to modulate the position, alignment and stabilization of the maxillary segments prior to the first surgery. Although it is widely used, its effectiveness is currently controversial. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified 14 systematic reviews that included 57 primary studies, five of which correspond to randomized trials. We conclude that it is uncertain whether presurgical orthopedics improves or deteriorates maxillary morphology, because the certainty of the evidence has been very low. On the other hand, presurgical orthopedics may make little or no difference to facial growth and development, occlusal alterations, parental satisfaction, feeding, speech, and facial and nasolabial appearance, but the certainty of the evidence is low.

Frecuencia de ansiedad y depresión en pacientes coordinados para cirugía electiva en el Hospital de Clínicas Manuel Quintela / Frequency of anxiety and depression in patients coordinated for elective surgery at the Hospital de Clínicas Manuel Quintela

Los trastornos depresivos y de ansiedad son más frecuentes en pacientes que se encuentran a la espera de un acto anestésico-quirúrgico. Estos se consideran factores de riesgo de complicaciones posoperatorias de allí el interés de detectarlos en la consulta preoperatoria. El objetivo del trabajo fue determinar la frecuencia de ansiedad y depresión en pacientes pre-quirúrgicos en el Hospital de Clínicas utilizando la Escala de Ansiedad y Depresión Hospitalaria (Hospital Anxiety and Depression Scale) validada en español mediante un estudio observacional, descriptivo y transversal. Se realizó una encuesta a una muestra tomada al azar, de pacientes prequirúrgicos obtenida de la consulta externa o de las consultas provenientes de salas de internación quirúrgica del Hospital de Clínicas entre julio y septiembre de 2019. La prevalencia global de ansiedad y depresión fue de 44% y 14,5%, respectivamente. Un mayor nivel de depresión fue asociado al sexo femenino, no encontrándose asociación entre otras variables como edad, tipo de cirugía u hospitalización, y la mayor frecuencia de cualquiera de los trastornos. Se concluye que los niveles de ansiedad son relativamente elevados y, junto a la depresión, pueden ser detectados en la consulta preoperatoria de manera sencilla utilizando el instrumento propuesto.

The depressive and anxiety disorders are more frequent in patients who are waiting a surgical procedure. These are risk factors of postoperative complications. The objective of this work was to determine the incidence of anxiety and depression in the preoperative period at the University Hospital using the Hospital Anxiety and Depression Scale validated in spanish through an observational, descriptive and cross-sectional study. A socio-demographic characterization of patients was carried out and aspects related to imminent surgery were described. The study was conducted in a random sample of pre-surgical patients who attended an outpatient clinic or were hospitalized at the Hospital de Clínicas, between July and September 2019. The global incidence of anxiety and depression was 44% and 14.5% respectively. A mayor level of depression was observed in females, no other statistically significant evidence was found to support an association between the other variables (age, type of surgery, hospitalization) and the higher prevalence of any of the disorders. We concluded that the level of anxiety is high in our population and deserves to be detected, through the implementation of a simple instrument.

Apendicitis aguda perforada con diagnóstico prequirúrgico y hernia inguinal bilateral en recién nacido de pretérmino / Acute perforated appendicitis with pre-surgical diagnosis and bilateral inguinal hernia in preterm infants

INTRODUCCIÓN: La apendicitis aguda neonatal es una patología de muy baja frecuencia, con escasos reportes en los últimos 30 años. La clínica e imágenes son inespecíficas, diagnosticándose la mayoría de las veces durante el procedimiento quirúrgico. OBJETIVO: Presentar un caso de apendicitis aguda perfora da en paciente prematura, con diagnóstico prequirúrgico y resolución laparoscópica, asociada a aparición posterior de hernia inguinal. CASO CLÍNICO: Recién nacido femenino de 34 semanas que a los 17 días de vida presentó fiebre, irritabilidad y aumento del residuo lácteo. Al examen físico destacaba distensión y sensibilidad del abdomen y tanto la radiografía como ecografía abdominales eran compatibles con apendicitis aguda perforada, por lo cual ingresó a pabellón para laparoscopía. Confirmado el diagnóstico, se realizó apendicectomía. Dos semanas después en consulta ambulatoria, se evidenció y confirmó con ecografía una hernia inguinal bilateral que se corrigió quirúrgicamente. CONCLUSIÓN: La apendicitis aguda debe considerarse dentro de los diagnósticos diferenciales en neonatos con clínica de abdomen agudo, principalmente en prematuros. En este caso, la ecografía permitió realizar el diagnóstico pre-operatorio. La posible asociación con hernia inguinal, debiera motivar a examinar siempre conductos inguinales durante la evaluación con imá genes y en el procedimiento quirúrgico.

INTRODUCTION: Acute neonatal appendicitis is a rare pathology, with few reports in the last 30 years. Since its clinical presentation and imaging studies are non-specific, most cases are diagnosed during a surgical pro cedure. OBJECTIVE: To describe a neonatal case of acute perforated appendicitis associated with later appearance of inguinal hernia, with pre-surgical diagnosis and treated through laparoscopy. CLINICAL CASE: A 17-day-old preterm female newborn presented with fever, irritability, and increased milk intolerance. Physical examination showed abdominal distention, tenderness and both, abdominal X- ray and ultrasound showed compatible images with acute perforated appendicitis. Once the diagnosis was confirmed, we performed an appendicectomy through laparoscopy. Two weeks later, during an outpatient visit, we observed a bilateral inguinal hernia which was confirmed by ultrasound, and then it was surgically corrected. CONCLUSION: Acute appendicitis should be considered within the differential diagnosis in neonates with acute abdominal symptoms, mainly in premature infants. In this case, ultrasound scan allowed us to make the pre-operative diagnosis. The possible association with inguinal hernias should motivate to examine inguinal ducts during imaging assessment and surgical procedure.

Moldeado nasoalveolar prequirúrgico de un paciente con labio y paladar hendido unilateral izquierdo / Presurgical nasoalveolar molding in a patient with left unilateral cleft lip and palate

Resumen Introducción: El labio y paladar hendido son malformaciones craneofaciales que se presentan en 1:1000 nacidos vivos en Colombia. Realizar un moldeado nasoalveolar previo a la cirugía favorece el reposicionamiento de los cartílagos nasales deformados y de los procesos alveolares. Objetivo: Dar a conocer a los profesionales la importancia de realizar moldeado nasoalveolar en un paciente con labio y paladar hendido antes de la intervención quirúrgica. Materiales y métodos: En la clínica odontológica de la Universidad del Sinú de Montería (Córdoba, Colombia), se atendió una paciente de 17 días de nacida que presentaba labio y paladar hendido completo unilateral izquierdo severo. Luego de diligenciar la historia clínica odontológica, se realizó placa de órtesis, que se cambió cada 15 días y se hizo el retoque del "tutor" cada 8 días. Resultados: La placa de órtesis permitió un moldeado naso alveolar, con el progreso en la alimentación y mejoras en el contorneado de los tejidos nasales, que mejoró la preparación para la operación de la hendidura a los 8 meses de edad. Conclusiones: La importancia del moldeado nasoalveolar en casos como el presentado, es propiciar mejores condiciones físicas, favoreciendo la ingesta de alimentos y beneficiando la apariencia física.

Abstract Introduction: Cleft lip and palate is a craniofacial birth defect that accounts for 1:1000 live birhts in Colombia. Performing nasoalveolar molding before surgery facilitates the reshaping of deformed nasal cartilage and alveolar processes. Objective: To make professionals aware of the importance of performing nasoalveolar molding in a patient with cleft lip and palate before surgical intervention. Materials and methods: A 17-day-old infant with a full left unilateral cleft lip and palate was treated at the dental clinic of the University of Sinú, Montería (Córdoba, Colombia). Once the dental clinical history was recorded, an orthosis plate was made. The plate was changed every 15 days and the molding appliance was repositioned every 8 days. Results: The orthosis plate promoted nasoalveolar molding, which facilitated feeding and improved the shape of nasal tissues. Consequently, this early intervention improved the preparation for the surgery of the cleft when the child reached 8 months of age. Conclusions: Nasoalveolar molding in patients with full cleft lip and palate is important to promote better physical conditions, which favor food intake and benefit their physical appearance.

Preparação psicológica pré-cirúrgica: estresse e ansiedade em crianças submetidas a cirurgias eletivas / Psychological preparation pre-surgical: stress and anxiety in children under the surgery

Este artigo apresenta uma pesquisa que avaliou os efeitos da preparação psicológica pré-cirúrgica sobre o estresse e a ansiedade de crianças submetidas a cirurgias eletivas, utilizando-se de três programas distintos de preparação e um grupo de controle. A pesquisa foi realizada com 80 participantes, divididos em quatro grupos, usuários de um Hospital infantil e utilizou-se a Escala de Stress Infantil (ESI) e o Inventário de Ansiedade Traço-Estado (IDATE-C). Realizaram-se três etapas distintas: a) aplicação da ESI e do IDATE-C antes da preparação para cirurgia, no dia anterior a mesma; b) a preparação psicológica pré-cirúrgica; e c) a reaplicação da ESI e do IDATE-C, depois da preparação. Os resultados mostraram que há significativa redução do nível de estresse e da ansiedade, embora não tenha havido diferença estatística significativa quanto ao tipo de programa utilizado, seja vídeo, boneco ou informação. Discute-se as implicações práticas para o atendimento psicológico das crianças em situação pré-cirúrgica e as limitações desta pesquisa. Conclui-se que o preparo psicológico pré-cirúrgico foi efetivo, independente da metodologia utilizada.

This article presents a study that evaluated the effects of the pre-surgical psychological preparation for the stress and anxiety of children undergoing elective surgery, using three different preparation programs and a control group. The research had a quantitative delineation, and made intra and inter-group comparisons. It was performed with 80 participants, divided into four groups, users of a Children's Hospital and used the Child Stress Scale (ESI) and the Trait Anxiety Inventory-State (STAI-C). There were three distinct steps: a) application of ESI and IDATE-C before preparation, the day before the surgery; b) the preparation itself, in groups submitted to different preparation programs; c) reapplying from STAI and ESI-C after preparation. The results showed that there is a significant reduction in the level of stress and anxiety after preparation, although there was no statistically significant difference in the type of program used. It is argued that there were practical implications for the psychological care of children in pre-surgical situation and limitations to consider when researching this area of pediatric psychology. We conclude that the preoperative psychological preparation is effective, regardless of the methodology used.

Advances of presurgical evaluation of drug-resistant epilepsy in children / 中华实用儿科临床杂志

Epilepsy mostly starts in childhood and can cause severe mental disorders.Treatment with antiepileptic drugs is effective in most patients, but 20%-30% of the patients continue to have uncontrolled seizures despite medical therapy, these are called drug-resistant epilepsy and need surgical treatment.Critical to discussion of surgical therapy are detailed presurgical evaluation and the lateralization and localization of epileptogenic zone.With deepening of the knowledge of epilepsy and progress of imaging technology, the evaluation of epilepsy surgery is changing gradually.Now, some methods and advances of surgical evaluation for children with drug-resistant epilepsy are reviewed.

Investigating the effect of pre-surgical orthodontic treatment on temporomandibular joint in patients with skeletal class Ⅲ malocclusion by cone-beam computed tomography / 华西口腔医学杂志

OBJECTIVE@#To investigate the effect of pre-surgical orthodontic treatment on temporomandibular joint (TMJ) in patients with skeletal class Ⅲ malocclusion treated with orthodontic-orthognathic surgical treatment.@*METHODS@#Twenty-four patients with skeletal class Ⅲ malocclusion who underwent orthodontic-orthognathic surgical treatment were included in the study. Before and after the completion of orthodontic treatment, the symptoms of TMJ were examined and recorded, and the short- and the long-axis diameter of the condylar (d), condylar height (h), joint space (L) at different angles, bilateral condylar spacing (R), and the condylar angles were measured, with scanning performed by using cone-beam computed tomography (CBCT). Then, the changes of TMJ symptoms and bone structure at different periods were analyzed.@*RESULTS@#No significant changes were observed in the joint symptoms before and after the pre-surgical orthodontic treatment. No significant changes were found in the measurements of the bone structure of TMJ in the dimensional direction (P>0.05).@*CONCLUSIONS@#In the orthodontic-orthognathic surgical treatment procedure, the pre-surgical orthodontic process does not have a significant effect on TMJ.

Neuronavegación En La Planificacion Prequirúrgica Y En La Cirugia De La Epilepsia Refractaria / Neuronavigation In Pre Surgical Planning And Surgery Of Refractory Epilepsy

RESUMEN Introducción: La epilepsia es una de las patologías neurológicas crónicas más frecuentes, con una incidencia de 50/100.000/año y una prevalencia entre 0,5 y 2% a nivel mundial. Un tercio de estos pacientes son resistentes al tratamiento con fármacos antiepilépticos, lo que se conoce como epilepsia refractaria. La mayoría de estos pacientes sufren de epilepsias focales secundarias a lesiones epileptogénicas evidenciadas cada vez más frecuentemente en correlación directa con las nuevas técnicas de neuroimagen cerebral. La cirugía de la epilepsia es el único tratamiento que podría curar la epilepsia de los pacientes con epilepsia refractaria. El objetivo de la cirugía de la epilepsia es remover la zona epileptogénica con preservación de las áreas elocuentes, y aquí la experiencia quirúrgica y la tecnología de neuroimagen juegan un papel capital. Objetivos: Demostrar la utilidad de la neuronavegación en la planificación prequirúrgica y en la cirugía de la epilepsia refractaria. Método: Estudio descriptivo transversal y analítico, en base a 47 cirugías realizadas (12 resectivas, 32 paliativas y 3 diagnósticas) en pacientes con epilepsia refractaria y edad media de 9,93 años (SD 4,1). En 27 pacientes (57.44%) se utilizó el neuronavegador. En el grupo de pacientes operados con neuronavegación disminuyó el tiempo quirúrgico en 47.17 minutos (p = 0,022), la cantidad de hemorragia en 111.41 mililitros (p = 0,011) y los días de hospitalización en 6.68 días (p = 0,005), en comparación con el grupo intervenido sin neuronavegación. Las complicaciones en el grupo con neuronavegación fueron del 29,63% en comparación con 65% en el grupo intervenido sin neuronavegación (p = 0,034). Conclusiones: En nuestra serie, el uso del neuronavegador en la planificación y desarrollo de la cirugía tuvo un impacto significativo al reducir la cantidad de hemorragia perdida, el tiempo quirúrgico, los días de hospitalización, y las complicaciones postquirúrgicas.

Abstract Introduction: Epilepsy is one of the more frequent neurologic disorders, with an incidence of 50/100,000/year and prevalence between 0.5 and 2% worldwide. A third of these patients suffer focal epilepsy due to epileptogenic lesions evident by Neuroimaging new techniques. Epilepsy surgery is the only treatment that can cure refractory epilepsy. Its goal is to remove the epileptogenic lesion with preservation of eloquent areas, and in this case both surgical experience and neuroimaging technology play a pivotal role. Objective: To demonstrate utility of neuronavigation in presurgical planning and surgery of refractory epilepsy. Method: Descriptive, cross sectional and analytic study of 47 performed surgeries (12 resective, 12 palliative and 3 diagnostic) in patients with refractory epilepsy with an average age of 9.93 years (SD 4.1). In 27 patients (57.44%) neuronavigation was used. In patients operated with assistance of neuronavigation, surgical time diminished in 47.17 minutes (p=0.022), hemorrhage in 111.41 ml (p=0.011) and days of hospitalization in 6.68 days (p=0.005) comparing with group without neuronavigation. Complications in the group with neuronavigation were 29.63% compared with 65% in the group without it. (P=0,034). Conclusions: In this study, using neuronavigation in planning and performing surgery in reducing the amount of blood loss, surgical time, days of hospitalization and post surgical complications.

Efeitos de Preparações Psicológicas Pré-Cirúrgicas sobre o Estresse e a Ansiedade de Meninos e Meninas / Efectos de la preparación psicológica prequirúrgica sobre el estrés y la ansiedad en niños y niñas / Effects of pre-surgical psychological preparations on stress and anxiety in boys and girls

Resumo A preparação infantil para a cirurgia é foco de atenção da equipe de saúde pelo potencial traumático dos procedimentos cirúrgicos e por ser fonte de estresse e ansiedade na infância. O impacto de três preparações psicológicas pré-cirúrgicas sobre o estresse e a ansiedade de crianças submetidas a cirurgias eletivas foi avaliado. A amostra foi composta por 80 crianças de um hospital infantil, a qual foi dividida em dois blocos de 40 sujeitos de acordo com o sexo e alocados aleatoriamente num dos quatro grupos: controle, preparação por informações verbais, preparação por jogo com kit de preparação ou preparação por vídeo informativo. O estresse e a ansiedade foram mensurados por meio da Escala de Stress Infantil (ESI) e do Inventário de Ansiedade Traço-Estado (Idate-c). A intervenção foi implementada em três etapas distintas: (a) aplicação da ESI e do Idate-c antes da preparação, no dia anterior a cirurgia; (b) a preparação propriamente dita nos grupos submetidos aos diferentes programas de preparação, também no dia anterior, e (C) a reaplicação da ESI e do Idate-c no dia da cirurgia. Os dados foram analisados por meio de equações de regressão simultâneas, e as estimativas são apresentadas em termos de diferença média padronizada e erro-padrão. Os resultados permitem inferir que a preparação com o vídeo reduziu o estresse (Tvídeo1= -38 ± .18) e a ansiedade (Tvídeo2 = - .54 ± .27), especialmente entre os meninos (TvídeoM1 = - .66 ± .25; TvídeoM2 = - .71 ± .38). Implicações práticas para a preparação psicológica das crianças em situação pré-cirúrgica e limitações da pesquisa são discutidas.

Resumen La preparación infantil para una cirugía es el centro de atención del equipo de salud debido al potencial traumático de los procedimientos quirúrgicos y debido a que es una fuente de estrés y ansiedad en la infancia. En la presente investigación se evaluó el impacto de tres formas de preparación psicológica prequirúrgica ante el estrés y la ansiedad de los niños sometidos a cirugía electiva. La muestra estuvo constituida por 80 niños de un hospital infantil, divididos en dos bloques de 40 sujetos según el sexo, y asignados al azar a uno de cuatro grupos: control, preparación a través de información verbal, preparación a través de juego con el kit de preparación, o preparación a través de video informativo. Se utilizó la Escala de Estrés Infantil (ESI) y el Inventario Ansiedad Estado-Rasgo para niños (STAIC) para medir el estrés y la ansiedad de los niños. La intervención se llevó a cabo en tres etapas distintas: (a) aplicación del ESI y el STAIC antes de la preparación, el día anterior a la cirugía; (b) preparación propiamente dicha en los grupos de los diferentes programas de preparación el día anterior; y (C) reaplicación del ESI-C y el STAIC el día de la cirugía. El análisis de los datos se hizo mediante ecuaciones de regresión simultáneas y las estimaciones se presentan por medio de la diferencia entre medias estandarizada y de la desviación estándar. Los resultados permiten inferir que la preparación con video redujo el estrés (Tvideo1 = -.38 ± .18) y la ansiedad (Tvideo2 = -.54 ± .27), especialmente en los niños (TvideoMl = -.66 ± .25; TvideoM2 = -.71 ± .38). Al final se discuten las implicaciones prácticas para la preparación psicológica de los niños en situación prequirúrgica y las limitaciones de la investigación.

Abstract Child preparation for surgery is a focus of attention of health teams due to the traumatic potential of surgical procedures and for being a source of stress and anxiety in childhood. The impact of three pre-surgical psychological preparations on stress and anxiety of children undergoing elective surgery were evaluated. The sample consisted of 80 children from a children's hospital, divided into two blocks of 40 subjects according to gender and randomly assigned to one of four groups: control, preparation by verbal information, preparation by game and preparation kit or preparation by informational video. Stress and anxiety were measured using the Escala de Stress Infantil (ESI) (Child Stress Scale) and the State-Trait Anxiety Inventory for Children (STAIC). The intervention was implemented in three distinct stages: a) application of ESI and STAIC before preparation, the day before surgery; b) actual preparation, in groups submitted to different preparation programs, also on the previous day; and c) reapplication of ESI and STAIC on the day of surgery. Data were analyzed using simultaneous regression equations, and estimates are presented in terms of standardized mean difference and standard error. Results allow to infer that preparation by video reduced stress (Tvideo1 = -0.38±0.18) and anxiety (Tvideo2 = -0.54±0.27), especially among boys (TvideoM1 = -0.66±0.25; TvideoM2 = -0.71±0.38). Practical implications for the psychological preparation of children in pre-surgical situations and the limitations of this study are discussed.

Modificações comportamentais entre o pré e o pós-operatório de pacientes bariátricos / Bariatric patients’ behavioral changes between preoperative and postoperative stages / Los cambios de comportamiento entre el pre y el post-operatorio de pacientes bariátricos

Esta pesquisa buscou conhecer as mudanças no comportamento alimentar do paciente bariátrico, analisando a função desse repertório antes e depois da cirurgia. Investigou-se também o processo de avaliação psicológica préoperatória, o acompanhamento terapêutico realizado nesse contexto bem como a existência ou não de repertórios alternativos ao comportamento alimentar que auxiliem no manejo do pós-cirúrgico. Os dados foram coletados em entrevistas semiestruturadas com 15 pessoas que realizaram a cirurgia. Os resultados indicaram que, antes do procedimento, o alimentarse era primordialmente mantido por reforço negativo, mas também por reforço positivo. Contudo o relato do pós-cirúrgico mostrou poucas alterações na função desse comportamento bem como a inexistência de repertórios alternativos, indicando probabilidade aumentada de, em longo prazo, de os sujeitos retornarem ao seu padrão nutricional anterior e viverem a reengorda. Em relação à avaliação psicológica e ao acompanhamento terapêutico, verificaram-se esses processos como pouco efetivos entre os procedimentos pré e pós-operatórios.

This research aimed to know the changes in a bariatric patient’s feeding behavior, analyzing the function of this repertoire before and after surgery. It also investigated the process of preoperative psychological evaluation, therapeutic monitoring conducted in this context, and the existence or lack of existence of alternative options for eating behavior which help to assist in the management of post-surgical period. Data were collected from semistructured interviews with fifteen people who underwent the surgery. The results indicated that before the procedure, the food itself was primarily maintained by both, negative and positive reinforcement. However, the reporting on post-surgical stage showed little change in the function of this behavior, as well as the absence of alternative options, indicating increasing likelihood of subjects returning, in a long run, to their previous nutritional status, and regaining lost weight. Psychological assessment and therapeutic monitoring processes proved to be ineffective in between preoperative and postoperative procedures.

Esta investigación tuvo como objetivo conocer los cambios en el comportamiento alimentario del paciente bariátrico, analizando la función de este repertorio antes y después de la cirugía. También se investigó el proceso de evaluación psicológica preoperatoria, el seguimiento terapéutico realizado en este contexto, así como la existencia de repertorios alternativos para la conducta alimentaria que ayuden en el acompañamiento post quirúrgico. Los datos se obtuvieron de entrevistas semi-estructuradas con quince personas que se sometieron a cirugía. Los resultados indicaron que antes del procedimiento, el hecho de alimentarse se mantuvo principalmente por el refuerzo negativo, pero también por el refuerzo positivo. Sin embargo, el informe post quirúrgico mostró pocos cambios en la función de este comportamiento, y la ausencia de repertorios alternativos, lo que indica una mayor probabilidad de que a largo plazo, los sujetos vuelvan a su estado nutricional previo y experimenten aumento de peso. En cuanto a la evaluación psicológica y al seguimiento terapéutico, se observaron estos procesos como ineficaces entre el pre y el post-operatorio.

Verification of dipole fit source localization in patients with epilepsy using postoperative MRI

@#Objective: Dipole fit source (DFS) localisation is a non-invasive imaging process used to identify the epileptogenic zone (EZ) in the brain. The purpose of the present study was to verify the use of DFS localisation for identifying the EZ in patients with and without lesions using magnetic resonance imaging (MRI). Methods: In this study, DFS localisation was used in 16 patients, of whom 7 had no lesions and 9 had lesions on MRI post-surgery, with at least 3 years of follow-up data. For DFS localisation, different scalp electroencephalogram (EEG) ictal activity was assessed (ictal spikes, rhythmic, paroxysmal fast, and obscured activity). DFSs were superimposed with postoperative MRIs to confirm the accuracy of the determined EZs. Results: The DFS correctly identified EZ localization within the resection area in 14 of the 16 patients. These 14 patients were all seizure free after surgery. The two remaining patients, in whom the DFS was adjacent to the resected area, had a decreased seizure frequency following surgery.Conclusions: DFSs determined during preoperative evaluations can provide information on EZ lateralisation and localisation and contribute to the presurgical decision process. Thus, the accurate identification of EZ boundaries is important and can be achieved more reliably with the use of multiple quantitative EEG analysis methods.

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors / 上海交通大学学报（医学版）

Objective·To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods·A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results·A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification,there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zonesⅠ + Ⅱ + Ⅲ + Ⅳ , 1 in zones Ⅰ + Ⅳ , 1 in zones Ⅱ + Ⅳ , and 1 in zone Ⅳ. The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion·CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.

Application of CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors / 上海交通大学学报（医学版）

Objective·To explore the value of applying CT/MRI image registration and fusion combined with 3D printing technique in pre-surgical planning of refractory pelvic tumors. Methods·A retrospective analysis was performed on the cases with refractory pelvic tumors admitted between March 2014 and December 2016 in Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. CT/MRI examinations were performed as a routine pre-surgical procedure, and the resulting images were subject to rapid registration and fusion with the Medraw software in order to accurately determine the tumor boundaries and to be used as references in designing and making patient-specific tumor models, prostheses, and implants by 3D printing technique. Results·A total of 13 cases with refractory pelvic tumors were included in this study (8 cases of chondrosarcoma, 1 case of osteosarcoma with aneurysmal bone cyst, 1 case of dedifferentiated sarcoma, 1 case of fibrous connective tissue hyperplasia, 1 case of solitary fibrous tumor/hemangiopericytoma, and 1 case of metastatic squamous cell carcinoma) with an average age of (50.0±8.5) years. According to the Enneking classification,there were 2 cases in zone Ⅰ , 2 in zones Ⅰ + Ⅱ , 1 in zones Ⅱ + Ⅲ , 3 in zones Ⅰ + Ⅱ + Ⅲ , 1 in zones Ⅰ + Ⅱ + Ⅳ , 1 in zonesⅠ + Ⅱ + Ⅲ + Ⅳ , 1 in zones Ⅰ + Ⅳ , 1 in zones Ⅱ + Ⅳ , and 1 in zone Ⅳ. The mean maximal tumor diameter was (15.15±4.81) cm without implicating the pelvic blood vessels. Results from intraoperative frozen section at resection boundaries and the installation of prosthesis showed that the actual surgical procedure was consistent with the surgical planning based on the reported image fusion technique. Conclusion·CT/MRI image registration and fusion technique combined with 3D printing technique can accurately determine the resection boundary of pelvic tumors and assist in designing of individualized prosthesis model and surgical guide, which has a great value in pre-surgical planning and clinical treatment of refractory pelvic tumors.

Importância da eletrocardiografia como um exame pré-cirúrgico em cães / Importance of electrocardiography as a pre-operative examination in dogs

Foi analisado o perfil eletrocardiográfico pré-cirúrgico de 124 cães submetidos a diferentes intervenções cirúrgicas com objetivo de relacionar as variáveis idade, sexo, porte, ausência ou presença de alterações cardiovasculares detectadas durante o exame físico e afecção cirúrgica com os achados eletrocardiográficos. Não foi observada associação entre essas variáveis e as alterações eletrocardiográficas. Um total de 79 animais (63,7%) apresentou algum tipo de alteração no eletrocardiograma. Assim, este estudo sugere que o exame eletrocardiográfico pré-cirúrgico é de grande valia, independente do sexo, idade, peso, histórico ou sinais clínicos associados a doença cardíaca.(AU)

An analysis of the pre-surgical electrocardiographic profile was made of 124 dogs submitted to different surgical interventions to correlate the variables age, sex, size, absence or presence of cardiovascular abnormalities detected during physical examination and of the surgical cases with electrocardiographic findings. No association between these variables and electrocardiographic changes were observed. A total of 79 cães (63.7%) showed some type of change in the electrocardiogram. The study suggests that pre-surgical electrocardiographic examination is of great importance, regardless of sex, age, weight, historic or clinical signs associated with heart disease.(AU)

Three-dimensional analysis of alveolar changes of complete unilateral cleft lip patients after presurgical nasoalveolar molding treatment / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study analyzed the alveolar changes of complete unilateral cleft lip (UCCL) patients after pre-surgical nasoalveolar molding (PNAM) treatment using a three-dimensional method.</p><p><b>METHODS</b>Palate impressions of thirty UCCL patients who underwent PNAM treatment in the Affiliated Stomatology Hospital of Guangxi Medical University were taken pre- and post-PNAM. The plaster impressions were scanned using cone beam computed tomography (CBCT). The DICOM files were exported and 3D models reconstructed in Mimics 15.0. The following parameters were analyzed in SPSS 17.0: cleft alveolar gap width, alveolar arch end width, upper lip frenulum-median plane distance, alveolar shift distance, and length of alveolar section.</p><p><b>RESULTS</b>After PNAM treatment, the cleft alveolar gap width and upper lip frenulum-median plane distance decreased significantly (P<0.05). No statistically significant change was observed in the alveolar arch end width (P>0.05). Alveolar shift distances for both sides increased significantly (P<0.05), and the shift distance of major alveolar sec-tion had a more significant increase than the minor alveolar section. The lengths of the alveolar section of both sides increased significantly (P<0.05) with the length of the major alveolar section increasing more significantly than the minor alveolar section.</p><p><b>CONCLUSIONS</b>The impression-CBCT method supply accurate three-dimensional data of the alveolar process. The PNAM treatment can significantly correct alveolar deformity and improve appearance.</p>

“Manifestos do Coração”: Significados Atribuídos à Doença por Pacientes Cardíacos Pré-cirúrgicos / “Manifestations of the Heart”: Meanings Attributed to the Disease by Pre-surgical Cardiac Patients

RESUMOEste estudo objetivou explorar os significados atribuídos à doença cardíaca por pacientes cardíacos pré-cirúrgicos em tratamento ambulatorial no sul do Brasil. É um estudo clínico-qualitativo, de caráter exploratório e descritivo, cuja coleta de dados aconteceu por meio de entrevistas semiestruturadas e da autofotografia, propostas a 15 indivíduos. Foi realizada análise de conteúdo temática, emergindo as categorias: Confrontação com a doença: os saberes em questão, Negação da doença, Doença e trabalho e Sexualidade rompida. Os resultados destacaram as dificuldades dos participantes relacionadas à apropriação do quadro da doença e à aceitação dessa condição. Salienta-se a premência de ações de saúde, que possam ser coadjuvantes na reestruturação das possibilidades de vida para os pacientes cardíacos pré-cirúrgicos.

ABSTRACTThis study aimed to explore the meanings attributed to the cardiac disease by pre-surgical outpatients in the South of Brazil. It is a clinical and qualitative study, characterized as exploratory and descriptive. Data was collected through semi-structured interviews and auto-photography, proposed to 15 individuals. The use of thematic analysis resulted in the following categories which emerged: Confrontation with the disease: questioning existing knowledge, denial of the disease, disease and work, and ruptured sexuality. Results highlighted difficulties of the participants in regards to the appropriation of the disease condition as well as its acceptance. This result points out the need for health care actions that may help cardiac pre-surgical patients to restructure their possibilities of life.

Tratamiento ortodóncico prequirúrgico para la corrección de anomalías esqueléticas graves del complejo cráneo-facial / Presurgical orthodontic treatment for the improvement of severe skeletal anomalies of the craneofacial complex

Con la presente revisión bibliográfica se aportan elementos sobre la aplicación del tratamiento ortodóncico prequirúrgico en pacientes mayores de 18 años con anomalías esqueléticas graves del complejo cráneo-facial, quienes deben ser atendidos por un equipo multidisciplinario de Cirugía Ortognática. Al respecto, el trabajo del ortodoncista resulta de suma importancia en la predicción y planificación del procedimiento quirúrgico en aquellos que no mejoran con tratamiento ortodóncico o con cualquier otra terapéutica similar. Se concluyó que la detección y el diagnóstico temprano por los ortodoncistas de las diferentes áreas de salud en el segundo nivel de atención, posibilita el empleo de técnicas correctivas que proporcionan mejores condiciones, antes de que el afectado con dichas deformidades esqueléticas reciba algún procedimiento quirúrgico ortognático.

With the present literature review elements are offered on the role of the presurgical orthodontic treatment in patients older than 19 years with marked skeletal anomalies of the craneofacial complex, who should be assisted by a multidisciplinary team for orthognatic surgery. In this respect, the work of the orthodontist is of extreme importance in the prognosis and planning of the surgical procedure in those who have no improvement with the orthodoncic treatment or with any other similar therapy. It is concluded that the detection and the early diagnosis by the orthodoncist of the different health areas in the second care, facilitate the use of correction techniques which provide better conditions, before the affected patient with these skeletal deformities receives a surgical orthognatic procedure.

Analysis of factors influencing short-term effect of presurgical pharmacological therapy and transsphenoidal microsurgery for somatotropinomas / 实用医学杂志

Objective To analyze factors influencing short-term effect of presurgical pharmacological thera-py and transsphenoidal microsurgery for somatotropinomas. Methods The clinical data of 53 patients underwent presurgical pharmacological therapy and transsphenoidal surgery for somatotropinomas were retrospectively analyzed in order to search for factors influencing effect of presurgical pharmacological therapy and transsphenoidal surgery for somatotropinomas. Results Serum GH inhibition rates decreased<50.00%from baseline in 62.26%of patients receiving presurgical pharmacological therapy. Statistical analysis concerning the influence of sex , neuropathological evaluation, tumor size and presence of invasion on presurgical pharmacological therapy effect were performed using a chi-squared test, no significant correlation was found among these factors and presurgical pharmacological therapy effect. Total remission rates were 43.40%, Statistical analysis concerning the influence of sex , neuropathological e valuation, tumor size, presence of invasion and presurgical pharmacological therapy effect on remission rate were performed using a chi-squared test, a significant correlation was found among tumor size, presence of invasion, presurgical pharmacological therapy effect and remission rate , while no significant correlation was found among the rest of the factors. Further Logistic regression analysis demonstrated a significant correlation among tumor size , presence of invasion and remission rate , while no significant correlation was found between presurgical pharmacolog-ical therapy effect and remission rate. Conclusions Presurgical pharmacological therapy effect revealed no signifi-cant correlation with sex, neuropathological evaluation, tumor size or presence of invasion. Total remission rate cor-related with tumor size and presence of invasion. A better presurgical pharmacological therapy effect may indicated a better outcome, while postoperative remission rate revealed no significant correlation with presurgical pharmacologi-cal therapy in our series.

Clinical study of neoadjuvant therapy of tyrosine kinase inhibitor in high-risk renal cell carcinoma / 中华泌尿外科杂志

Objective To investigate the safety and clinical significance in presurgical application of tyrosine kinase inhibitor (TKI) targeted therapy in high-risk renal-cell-carcinoma patients.Methods TKI targeted therapy was applied to 33 high-risk renal-cell-carcinoma patients from Jun.2010 to Dec.2013,7 cases with paraneoplastic symdromes and 1 with bilateral lesions received surgical treatments.There were 6 males and 2 females in this group with average age of 50 (42-56) years.They were high-risk patients because of renal tumor and vena caval tumor thrombus in 3 cases,renal tumor and vena caval tumor thrombus and hypercalcinemia in 1 case,renal tumors with metastasis to lung and lymph nodes in 2 cases,renal tumor with metastasis to lung and bones in 1 cases,and bilateral kidney cancer in 1 case.The clinical stages included 3 cases of T3aN1M1 and T3bN0M0 respectively,and 1 case of T3bN0M1 and T3aN0M0,respectively.The primary metastasis sites were lymph nodes and lung (3 cases respectively),and another 1 in bone.4 cases suffered from vena cava tumor thrombi with 3 staged Mayo Ⅲ and 1 Mayo Ⅳ.7 cases with paraneoplastic syndromes were contra-indicated for surgery due to poor ECOG performance score (with score 3 in 3 cases and 2 in 4 cases).4 cases received Sorafinib 400mg po bid and the other 4 Sunitinib 50 mg po qd,4 weeks on and 2 weeks off,with duration of 8-12 weeks.Medical therapy ceased 6 to 16 days (median 12 days) before operation.Results Patients with neoadjuvant therapy experienced good toleration.The 7 cases with poor ECOGs improved during medical therapy.The tumor sizes in the bilateral lesions shrunk remarkably.All 7 patients received surgery:3 radical nephrectomies,4 nephrectomies and resections of Vena Caval tumor thrombus,and 1 bilateral lesions underwent nephron sparing surgery.Operations were successful though with mild to moderate adhesion,and the blood loss ranged from 120 to 500 ml,with averaged of 280 ml.Pathologic results were clear-cell renal carcinomas.All incisions were well-healed.4 patients with metastasis continued TKI therapy.All patients were alive without recurrence during the follow-up of 4 to 42 mon.Conclusions Presurgical application of targeted therapy is safe and may increase the opportunity of surgery for some patients with poor general situation,also patients with bilateral lesions may benefit from it for its possibility of nephron sparing.