Como evitar uma retração no meio da cicatriz horizontal e minimizar o risco de necrose nas abdominoplastias clássicas / How to avoid a retraction in the middle of the horizontal scar and minimize the risk of necrosis in the classic abdominoplasty

Introdução: Nas abdominoplastias clássicas, um resultado indesejado após o tracionamento do retalho abdominal é a ocorrência de uma retração suprapúbica, no meio da cicatriz horizontal quando esta coincide com o ponto superior da antiga cicatriz umbilical. Métodos: Foram avaliadas 45 pacientes submetidas à dermolipectomia abdominal associada à lipoaspiração de todo o abdome e flancos, com decorticação de uma área suprapúbica cerca de 5 cm acima da marcação inicial da linha de incisão, com posterior fixação na borda inferior do retalho abdominal. Resultados: Não foram observadas depressões ou necroses na região suprapúbica. Conclusão: Observamos, nos casos operados, que a presença de um coxim dermogorduroso na porção central da linha de sutura nas abdominoplastias clássicas, associada à reconstituição completa dos planos cirúrgicos e fixação deste coxim no retalho abdominal superior, evita a ocorrência de depressões nesta região, evita ocorrência de necroses e melhora a qualidade da cicatriz por redução da tensão de tração sobre os tecidos.

Introduction: In classic abdominoplasty, an undesirable result after abdominal flap traction is the occurrence of a suprapubic retraction in the middle of the horizontal scar when it coincides with the superior point of the old umbilical scar. Methods: Forty-five patients underwent abdominal dermolipectomy associated with liposuction of the entire abdomen and flanks, with decortication of the suprapubic area approximately 5 cm above the initial marking of the incision line, with posterior fixation at the lower border of the abdominal flap. Results: No depressions or necroses were observed in the suprapubic region. Conclusion: We observed that the presence of a dermofat flap in the central portion of the suture line in the classic abdominoplasties associated with the complete reconstruction of the surgical planes and the fixation of this flap in the upper abdominal flap avoids the occurrence of depressions in this region, prevents occurrence of necrosis, and improves the quality of the scar by reducing the tensile stress on the tissues.

The effectiveness of heparin, platelet-rich plasma (PRP), and silver nanoparticles on prevention of postoperative peritoneal adhesion formation in rats

Purpose: To assess the effectiveness of heparin, platelet-rich plasma (PRP), and silver nanoparticles on prevention of postoperative adhesion in animal models. Methods: Sixty males Albino Wistar rats aged 5 to 6 weeks were classified into five groups receiving none, heparin, PRP, silver nanoparticles, PRP plus silver nanoparticles intraperitoneally. After 2 weeks, the animals underwent laparotomy and the damaged site was assessed for peritoneal adhesions severity. Results: The mean severity scores were 2.5 ± 0.9, 2.16 ± 0.7, 1.5 ± 0.5, 2.66 ± 0.88, and 2.25 ± 0.62 in the control, heparin, PRP, silver and PRP plus silver groups, respectively with significant intergroup difference (p = 0.004). The highest effective material for preventing adhesion formation was PRP followed by heparin and PRP plus silver. Moreover, compared to the controls, only use of PRP was significantly effective, in terms of adhesion severity (p = 0.01) . Conclusion: Platelet-rich plasma alone may have the highest efficacy for preventing postoperative peritoneal adhesions in comparison with heparin, silver nanoparticles and PRP plus silver nanoparticles.

The application of percutaneous lysis of epidural adhesions in patients with failed back surgery syndrome / A aplicação da lise percutânea de aderências epidurais em pacientes com síndrome pós-laminectomia

PURPOSE: To investigate the efficacy and the feasibility of application of percutaneous lysis of epidural adhesions in failed back surgery syndrome (FBSS) using a stiff type guide wire and 4F vascular catheter. METHODS: Ninety two patients with FBSS were randomly divided into two groups, the control group (treated by injection dexamethasone only) and percutaneous lysis of epidural adhesions group. Visual analog scale scores (VAS) and therapeutic evaluation were observed in the preoperative, seven days postoperative, one month and six months postoperative. RESULTS: VAS scores for pain were significantly reduced in both groups at seven days. The VAS scores were in controlled group at one month, six months was significantly higher than that in epidural lysis group. However, there was no statistical difference in VAS scores of one month and six months when respectively compared to that of before operation in controlled group. Patients on epidural lysis reported clinical effectiveness rate was 50%. Patients on control was 5.26%, there was a statistical difference between two groups. CONCLUSION: Percutaneous lysis of epidural adhesions by using a stiff type guide wire and 4F vascular catheter is an effective method in the treatment of FBSS and it has a value in clinical application.

OBJETIVO: Investigar a eficácia e a exequibilidade da aplicação da lise percutânea de aderências epidurais na síndrome pós-laminectomia usando um fio-guia tipo Stiff e um cateter vascular 4F. MÉTODOS: Noventa e dois pacientes com síndrome pós-laminectomia foram randomizados em dois grupos: grupo controle (tratado somente com injeção de dexametazona) e grupo lise percutânea de aderências epidurais. Escores de escala visual analógica (VAS) e avaliação terapêutica foram observadas no pré-operatório, no sétimo dia de pós-operatório, um mês e seis meses de pós-operatório. RESULTADOS: Escores VAS para dor foram significantemente reduzidos em ambos os grupos aos sete dias. Os escores VAS foram mais altos no grupo controle comparado ao da lise epidural nos tempos de um mês e seis meses. Entretanto, não há diferença estatística nos escores VAS de um mês e seis meses quando comparados, respectivamente, àqueles de antes da operação do grupo controle. Pacientes com a lise epidural relataram taxa de eficiência de 50%. Nos pacientes do grupo controle foi 5,26%, havendo diferença estatística entre os dois grupos. CONCLUSÃO: A lise percutânea de aderências epidemias usando um fio-guia tipo Stiff e um cateter vascular 4F mostrou-se um método efetivo no tratamento de FBSS e tem valor na aplicação clínica.

Tratamiento de las plastrones apendiculares en pediatría: conservador v/s quirúrgico: ¿cuál es la mejor alternativa? / Treatment of appendiceal mass in children: conservative versus surgical management

Introducción: Existe discusión con respecto al manejo conservador versus quirúrgico en el tratamiento de los plastrones apendiculares, así como la necesidad de la apendicectomía diferida. Objetivo: Describir nuestra experiencia en el manejo de los plastrones apendiculares. Demostrar la utilidad del manejo médico conservador inicial y la validar la realización de la apendicectomía diferida. Material y método: Revisión de las fichas clínicas de los pacientes egresados con diagnóstico de plastrón apendicular entre enero 2000 a septiembre 2009. Se aplicó análisis estadístico a los resultados. Resultados: 107 pacientes, edad promedio de 8,50 años (2 a 14 años). 68 hombres y 39 mujeres. Se establecieron 2 grupos. El Grupo I constituido por 34 pacientes que se operaron al ingreso. Tiempo de evolución clínica 5,14 días en promedio. En 9 se palpó masa abdominal. Ningún paciente de este grupo contó con ecografía. Tiempo quirúrgico promedio 83 minutos. En 8 casos se presentaron complicaciones como abscesos residuales, obstrucción intestinal y necrosis con perforación intestinal. Tiempo de hospitalización 8,97 días en promedio. El Grupo II, 73 pacientes no se operaron y se manejaron con tratamiento antibiótico (endovenoso y oral). Días de evolución promedio de 6,6 días. 46 presentaban masa palpable y ecografía confirmatoria el 100 por ciento. No hubo complicaciones en este grupo. Tiempo de hospitalización promedio de 9,1 días. Se han realizado exploración laparoscópica diferida en 52 pacientes. Tiempo quirúrgico promedio 48,9 minutos promedio. Dentro de los hallazgos operatorios, en el 57,6 por ciento el apéndice se encontró con adherencias y posición anómala. La mayoría de las biopsias (68 por ciento) se informaron como normal y/o con inflamación. 13 pacientes presentaron un segundo episodio de apendicitis mientras esperaban la intervención diferida, siendo operados de urgencia. Conclusión: El tratamiento médico conservador inicial es de elección en los...

Juventude positiva e aderência aos medicamentos antiretrovirais: estudo de caso com adolescentes vivendo com HIV/AIDS do Rio de Janeiro / Positive youth and adherence to antiretroviral medications: case study of adolescents living with HIV / AIDS in Rio de Janeiro

No início da epidemia, no Brasil, crianças que nasciam soropositivas para o HIV, tinham expectativa de vida que não ultrapassava a infância. Em conseqüência, familiares e profissionais de saúde freqüentemente não se engajavam em ações voltadas a preparar estas crianças para encarar questões específicas da adolescência e maturidade, tais como comportamentos sexuais, decisões reprodutivas e outros aspectos relacionados. No entanto, com a implantação do acesso gratuito e universal à terapia anti-retroviral de alta potência (HAART), e conseqüente aumento da expectativa de vida de crianças nascidas com HIV / AIDS, esses pacientes começaram efetivamente a alcançar a adolescência e juventude. O presente estudo utilizou metodologia qualitativa para avaliar aspectos relacionados à aderência ao tratamento e comportamento sexual de adolescentes vivendo com HIV/AIDS infectados verticalmente. O estudo foi realizado em 2008, no Serviço de Doenças Infecciosas e Parasitárias – Ambulatório de DIP – Adolescentes do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (HUCFF/UFRJ). Foram realizadas 20 entrevistas semi-estruturadas, 18 com adolescentes vivendo com HIV/AIDS e 2 entrevistas com infectologistas responsáveis pelo atendimento desses pacientes. Os roteiros de entrevistas abordaram questões relativas ao comportamento sexual, conhecimentos e práticas relacionadas ao HIV/AIDS e aderência à HAART. Os participantes tinham idades entre 15-20 anos, em media 8 anos de educação formal e todos estavam em HAART. Dez participantes referiram serem sexualmente ativos. Participantes sexualmente ativos relataram que dificuldades relacionadas com a revelação do diagnóstico influenciavam sua habilidade de negociar o uso de preservativos...

In the beginning of Brazilian AIDS epidemic, children born with HIV had a low life expectancy. As a consequence, family members and health professionals didn’t organizedinterventions aiming to prepare those children for adolescence and adulthood common difficulties, such as sexual and reproductive life decisions, among other issues. With the free and universal access to highly active antiretroviral therapy (HAART), and the life expectancy increase for children born with HIV, those patients started experiencing adolescence andyoung adulthood. The study utilized qualitative methods to explore HIV-positive young adults’ lifestyles, behaviors and HIV-related knowledge that might influence their effectiveadherence to ART and maintenance of safer behaviors over time. The study was conducted during 2008 at the Service of Infectious Diseases, Clementino Fraga Filho UniversityHospital, Federal University of Rio de Janeiro (HUCFF/UFRJ). Twenty in-depth interviews were conducted, 18 with adolescents living with HIV/AIDS and 2 with physicians responsiblefor their treatment and care. Interview topics included sexual risk behavior, HIV/STI knowledge and attitudes, and adherence to HAART. Participants were 15-20 years old with around 8 years of formal education, all participants were on HAART, and ten reported beingsexually active. Sexually active participants reported that disclosure difficulties influenced their ability to negotiate condom use. The vast majority of participants reported a great effort to feel and act as “a normal human being”, therefore being accepted by their social group...

Efficacy of intra-and post-operative peritoneal lavage in prevention of experimental postsurgical peritoneal adhesions formation in donkeys

This study was carried out on twenty two donkeys subjected to jejunal and cecal serosal stripping adhesion induction model followed by intra- and post-operative peritoneal lavage for the first three postinduction days. The chosen antiadhesivc pharmaceuticals are dimethyl sulfoxide 20% solution; sodium chloride sterile solution containing 5000 IU heparin/liter; Ringer's lactate sterile solution containing 0.1% lavasept and 1% sodium carboxymethycellulose. From the quantitative macroscopic and histopathological adhesions score system and the clinicopathological findings insignificant differences was found in the postsurgical adhesions scores among peritoneal lavaged and control groups. The effectiveness of intraperitoneal lavage using dimethyl sulfoxidc, heparin, lavasept and sodium carboxymethylcellulose in the prevention of adhesions cannot be scientifically supported because the results were controversial and lacked any implication for clinical use. No method has gained wide acceptance and surgeons must rely on meticulous surgical technique which can minimize tissue trauma and reducing the risk of postsurgical adhesions formation

Use of colchicine in reduction or prevention ot talc-induced intra-abdominal adhesion bands

Postoperative peritoneal adhesion bands are one of the most common complications caused by foreign material. To investigate the effect of colchicine on talc-induced peritoneal adhesion bands. Method: Adhesion bands were induced in 30 short hair England Guinea pigs by introduction of talc-saline solution [10 mL, 10%] into the peritoneal cavity. Afterwards, the pigs were randomly divided into two equal groups and colchicine was orally given to the experimental group. Finally, laparotomy was performed and the adhesion bands in both groups were classified using the Nair classification and compared with each other. Only four [23%] out of 15 Guinea pigs of the target group developed substantial adhesions, while the other 11 [75%] pigs developed only insubstantial adhesions [grade 0-1]. On the other hand, the entire control group developed substantial adhesions. Colchicine, at a dosage of 0.02 mg/kg, prevented and reduced formation and severity of adhesion bands [p<0.05]. Therefore, given the safety, low cost and acceptable side effects, colchicine may be a useful agent for prevention or reduction of adhesion band formation. Human studies on this subject are warranted

Sinéquia intra-uterina: importância e tratamento / Intrauterine adhesions: importancy and treatment

Os autores fazem uma revisão e atualização sobre as sinéquias intra-uterinas (SIUs), enfocando principalmente sua importância atual e o método histeroscópico para o tratamento dessa afecção. Outros enfoques terapêuticos como a histerotomia no tratamento das SIUs totais, limitações do método histeroscópico e eventuais complicações obstétricas subseqüentes à sinequiolise histeroscópica são também discutidos neste trabalho

Cirugía ginecológica laparoscópica. Experiencia en el Hospital Luis Castelazo Ayala / Laparoscopic gynecological surgery. Experience at Hospital Luis Castelazo Ayala

El objetivo del presente estudio fue demostrar la aplicación de la cirugía laparoscópica en la solución quirúrgica de la patología ginecológica más frecuente. Se estudiaron 40 pacientes sometidas a procedimientos de cirugía laparoscópica divididas en cinco grupos: adherenciolisis, tratamiento de los tumores de ovario, histerectomía, cirugía tubaria y miomectomía. Todas las pacientes se sometieron a estudio preoperatorio y una vez completado éste, se seleccionaron para cirugía. Los resultados obtenidos de las 40 pacientes mostraron que la cirugía laparoscópica resolvió la patología presente en forma satisfactoria. El tiempo quirúrgico en general fue en promedio de 66.8 min, con tiempo máximo de 180 y mínimo de 30 min, de acuerdo con los grupos de cirugía los tiempos fueron: 1) adherenciolisis, tiempo quirúrgico promedio de 47 min, 2) cirugía de ovario 69 min, 3) histerectomía 113 min, 4)cirugía de trompa con promedio de 60 min y 5) miomectomía 58 min. Todos los procedimientos se realizaron con cauterio bipolar. No existieron complicaciones quirúrgicas. Las pacientes tuvieron breve estancia hospitalaria, así como reintegración rápida a la vida activa. Se concluye que la cirugía laparoscópica en la actualidad constituye un recurso útil para la resolución de la mayoría de la patología ginecológica benigna que cuando está indicada en forma adecuada no incrementa la morbi-mortalidad y ofrece una recuperación temprana de las pacientes

Tratamiento de la coalescencia de labios menores / Treatment of the labia minora coalescentia

Se trataron 203 casos de coalescencia de labios menores con crema de valerianato de difucortolona y clorquinaldol. Los resultados obtenidos en todas las pacientes fueron los esperados

Effects of local therapeutics on prevention of postoperative abdominal adhesions: experimental study

Visceral adhesions following abdominal surgery create major challenges that motivated surgeons to test a multitude of maneuvers and agents for their effectiveness in minimizing adhesion formation. This problem was studied experimentally in rats by induction of intraperitoneal adhesions. The rats were divided into 3 groups: The first was kept as control, Dextran solution was left in the peritoneal cavity of the second group, while in the third dexamethasone mixed with heparin in ringer's solution was left. In all groups, a standard cotton pellet was left in the abdomen before closure. After 15 days, the rats were reexplored and the grade of adhesions were recorded as well as the cotton pellet weight as an indicator for the amount of peritoneal reaction. The third group's agents have proved a superior antiadhesive effect, as the average grade of adhesion per animal was 1.6 [+1.19], compared with 1.85 [t = 1.19 in the second, and 2.6 [ +/- 0.99] in the first group. Also, the cotton pellet test showed 43.18% inhibition of adhesions in the third group and 37.78% in the second group as compared with the control group; but as Dextran has less side effects than cortisone and heparin, it is preferred as the first choice antiadhesive agent. The combination of cortisone and heparin are better reserved for selected cases with life threatening complications

Tratamiento médico de la obstrucción intestinal por bridas y adherencias / Medical treatment of intestinal obstruction due to adhesions

Adhesions are the most common cause of intestinal obstruction. Medical treatment for those patients with no signs of vascular involvement has been successful in many cases. We reveiwed the clinical records of 87 patients with intestinal obstruction due to adhesions, having a total of 122 episodes Satisfactory follow up was obtained in 76% of patients for a mean of 29.6 months 47% of episodes resolved without need for surgical intervention. Volumen entrapment during the first hours was correlated with need for surgical treatment (p < 0.01). Recurrences were not different between medical and surgical patients (p = 0.28). Thus, medical treatment of this type of intestinal obstruction may be attempted in most patients, not only those who are poor surgical risks

Capsulite adesiva: ombro congelado / Adhesive capsulitis: frozen shoulder

Após serem feitas consideraçöes cobre o termo "ombro congelado", enfatiza-se a definiçäo de capsulite adesiva como entidade nosológica própria. De acordo com a literatura säo descritos o quadro clínico, o radiológico, o tratamento e a hiosstória natural desta doença. O autor relata a experiência pessoal de cinco casos, destacando a importância do diagnóstico diferencial, o tratamento instituído e a evoluçäo quase sempre favorável desses processos

Terapêutica alternativa na coalescência de ninfas / Alternative therapy in adhesions of the labia minora

O objetivo deste trabalho é demonstrar a viabilidade de tratamento alternativo em casos de aglutinaçäo de pequenos lábios em crianças. A terapêutica preconizada baseou-se na utilizaçäo de vaselina sólida associada à massagem da área aderente. Discutem-se as vantagens sobre outras forma de tratamento