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1.
Rev. chil. cir ; 71(1): 15-21, feb. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-985373

RESUMO

Resumen Introducción: Conocer en detalle la inervación interna del músculo temporal humano permite realizar múltiples técnicas quirúrgicas y tratamientos de patologías que involucran al territorio craneofacial. Si bien en la literatura se ha descrito la inervación interna del músculo temporal humano basado en micro-disección directa, la técnica de tinción de Sihler es una herramienta ventajosa para el estudio anatómico ya que permite observar ramos nerviosos pequeños sin perder su relación tridimensional con las fibras musculares. Objetivo: Describir la distribución nerviosa al interior del músculo temporal humano en cadáveres al aplicar el método de Sihler y analizar su asociación anátomo quirúrgica. Materiales y Método: Ocho músculos temporales humanos previamente disecados fueron sometidos al método de tinción de Sihler. Cada una de las muestras se observó bajo lupa estereoscópica y transiluminación; finalmente para su descripción se dividió al músculo en tres regiones. Resultados: Se determinó la presencia de tres troncos nerviosos principales: el temporal profundo anterior, el temporal profundo medio y temporal profundo posterior, los que discurren de profundo a superficial. Además, se observaron ramos colaterales de menor calibre del nervio temporal profundo posterior que en forma de arco comunican las tres regiones del músculo. Conclusión: Se describió una distribución nerviosa interna común para los músculos estudiados en las tres dimensiones del espacio, conocimiento útil para innovar en terapias clínico-quirúrgicas del territorio craneofacial.


Introduction: Knowing in detail the inner innervation of the human temporal muscle allows to perform multiple surgical techniques and treatments of pathologies that involve the craniofacial territory. Although the internal innervation of the human temporal muscle based on direct microdissection has been described in the literature, the Sihler staining technique is an advantageous tool for anatomical study since it allows observing small nerve branches without losing its three-dimensional relationship with muscle fibers. Aim: To describe the nervous distribution within the human temporal muscle in cadavers by applying the Sihler method and analyzing its surgical anatomical association. Materials and Method: Eight previously dissected human temporal muscles were subjected to the Sihler staining method. Each one of the samples was observed under stereoscopic magnification and transillumination, finally for its description the muscle was divided into three regions. Results: The presence of three main nervous trunks was determined: the anterior deep temporal, the deep medium temporal and the posterior deep temporal, those that run from deep to superficial. In addition, collateral branches of lesser caliber of the posterior deep temporal nerve that in the form of an arc communicate the three regions of the muscle were observed. Conclusion: A common internal nervous distribution was described for the muscles studied in the three dimensions of space, useful knowledge to innovate in clinical-surgical therapies of the craniofacial territory.


Assuntos
Humanos , Músculo Temporal/fisiopatologia , Músculo Temporal/diagnóstico por imagem , Rede Nervosa , Músculo Temporal/cirurgia , Anormalidades Craniofaciais/patologia , Vias Neurais
2.
Int J Colorectal Dis ; 32(9): 1349-1356, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28634703

RESUMO

BACKGROUND: It is believed that loosing ileocecal valve is well tolerated in patients who do not have short bowel syndrome or Crohn disease. From the hypothesis of colonic peristalsis and transit is regulated by that ileocecal valvular mechanism, we try to find out if the creation of a new pseudo-valvular mechanism as antiperistaltic anastomosis could be considered after right hemicolectomy can cause any short- or long-term changes in gastrointestinal habits. PURPOSE: The purpose of the study at primary endpoint is to compare early (occurring within 30 days of surgery) and late (occurring during the follow-up) postoperative complications between both groups The purpose of the study at secondary endpoint is to compare intraoperative and postoperative events between experimental and control groups in terms of operating time, first oral tolerance day, first flatus and faeces, length of hospital stay and orocecal transit; comparing rates of gastrointestinal life quality and comparing mortality rates between both groups. METHODS: The ISOVANTI trial is a randomized controlled single-centre trial comparing isoperistaltic versus antiperistaltic side-to-side anastomosis after right laparoscopic hemicolectomy. It is designed as a parallel group superiority trial. CONCLUSIONS: It is unknown if a pseudo-valvular mechanism as antiperistaltic anastomosis can be considered has short- or long-term consequences in gastrointestinal habit. Considering the impact that ileocolic anastomosis configuration could have on the restitution of bowel transit after right hemicolectomy, we think it is indicated and necessary a randomized trial comparing iso- and antiperistaltic modalities. TRIAL REGISTRATION: NCT02309931.


Assuntos
Colectomia/métodos , Colo/cirurgia , Neoplasias do Colo/cirurgia , Constipação Intestinal/prevenção & controle , Laparoscopia , Peristaltismo , Anastomose Cirúrgica , Protocolos Clínicos , Colectomia/efeitos adversos , Colectomia/mortalidade , Colo/patologia , Colo/fisiopatologia , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Neoplasias do Colo/fisiopatologia , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Defecação , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/mortalidade , Qualidade de Vida , Recuperação de Função Fisiológica , Projetos de Pesquisa , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento
3.
Biomech Model Mechanobiol ; 15(4): 845-56, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26363917

RESUMO

In this work, we use an in-vitro mechanical test to explore the resistance of biaxially stretched vena cava tissue against deep perforation and a methodology which integrates experimental and numerical modeling to identify constitutive fracture properties of the vena cava. Six sheep vena cava were harvested just after killing, and cyclic uniaxial tension tests in longitudinal and circumferential directions and biaxial deep penetration tests were performed. After that, we use a nonlinear finite element model to simulate in vitro penetration of the cava tissue in order to fit the fracture properties under penetration of the vena cava by defining a cohesive fracture zone. An iterative process was developed in order to fit the fracture properties of the vena cava using the previously obtained experimental results. The proposed solutions were obtained with fracture energy of 0.22 or 0.33 N/mm. In comparison with the experimental data, the simulation using [Formula: see text], [Formula: see text], and [Formula: see text] parameters ([Formula: see text]) is in good agreement with results from penetration experiments of cava tissue. It is noticeable that the parameter estimation process of the fracture behavior is more accurate than the estimation process of the elastic behavior for the toe region of the curve.


Assuntos
Falha de Prótese , Filtros de Veia Cava , Veia Cava Inferior/fisiopatologia , Animais , Fenômenos Biomecânicos , Simulação por Computador , Elasticidade , Análise de Elementos Finitos , Análise Numérica Assistida por Computador , Ovinos , Estresse Mecânico
4.
Surg Endosc ; 30(1): 65-72, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25801109

RESUMO

BACKGROUND: Since the introduction of laparoscopic colorectal surgery, there has been a controversy between creating an intracorporeal or extracorporeal ileocolic anastomosis in right hemicolectomy. The purpose is to report our experience in intracorporeal anastomosis following right hemicolectomy in both malignant and benign pathologies. STUDY DESIGN: A retrospective review of a prospectively collected database was conducted at Virgen de la Arrixaca Clinical University Hospital (Murcia) between January 2000 and April 2014. The study includes all surgery patients who received a laparoscopic right hemicolectomy with an intracorporeal ileocolic anastomosis. The criteria for exclusion were conversion to open surgery during the procedure due to technical difficulties during dissect. Tumours considered T4 were not excluded, nor were stage IV patients or those with a history of previous abdominal surgery. RESULTS: There were 173 patients (63 females) aged 67 (range 14-91) years, with body mass index of 27 (17-52) kg/m(2) and ASA 1:2:3:4 of 12:78:68:15; 41% had previous abdominal surgery and 70% had a pre-existing comorbidity. Operating time was 142 (60-270) min. Specimen extraction site incision length was 8.1 (6-11.1) cm. Conversion rate was 9.2%, and there were 39 complications (22.54%) and 9 reoperations (5.2%). Readmission rate was 5.2%. Length of stay was 5.7 (1-35) days. CONCLUSION: The intracorporeal procedure is a safe and feasible alternative for creating an ileocolic anastomosis. It involves a similar rate of complications and may prevent some of the drawbacks presented by extracorporeal anastomosis.


Assuntos
Colectomia/métodos , Colo/cirurgia , Íleo/cirurgia , Laparoscopia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Conversão para Cirurgia Aberta , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Reoperação , Estudos Retrospectivos , Adulto Jovem
5.
Obes Surg ; 25(10): 1796-801, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25820625

RESUMO

BACKGROUND: Different anastomotic techniques have been evaluated during a laparoscopic Roux-en-Y gastric bypass (RYGB); however, no techniques have proven to be better than any other regarding complications and the percentage of weight loss (excess weight loss (%EWL)), and there are few controlled prospective studies to compare them. METHODS: A randomized, prospective study was conducted in 238 patients undergoing RYGB for morbid obesity between July 2008 and September 2012 to compare the early and late postoperative complications between the two surgical techniques: gastrojejunal hand-sutured anastomosis (HSA) and circular-stapled anastomosis (CSA). Minimum follow-up was 24 months. RESULTS: The two groups of patients were similar for demographic data and preoperative comorbidities. There were no significant differences between the surgical techniques regarding %EWL at 3, 12, and 24 months. The patients with CSA had a greater frequency of postoperative gastrointestinal bleeding (GIB) (4.2 vs. 0%, p = 0.024) and surgical wound infection (11.1 vs. 3.4%, p = 0.025) than the patients with HSA, with no significant differences in the other early complications. There were no significant differences in either group for late complications (gastrojejunal anastomosis (GJA) stricture, marginal ulcer, GJA perforation, bowel obstruction, and eventration). No significant differences were observed in operative time, rate of reoperation and postoperative length of hospital stay. CONCLUSIONS: HSA and CSA were techniques with similar safety and effectiveness in our study. HSA had a lower rate of bleeding complications and surgical wound infection, although it does require greater experience in laparoscopic hand suturing.


Assuntos
Anastomose em-Y de Roux , Derivação Gástrica/métodos , Obesidade Mórbida/cirurgia , Técnicas de Sutura , Adulto , Anastomose em-Y de Roux/métodos , Comorbidade , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Grampeamento Cirúrgico/efeitos adversos , Grampeamento Cirúrgico/métodos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos , Redução de Peso/fisiologia
6.
Dis Colon Rectum ; 57(12): 1391-6, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25380005

RESUMO

BACKGROUND: Postoperative ileus is the most common complication after ileostomy closure with an increase in morbidity, hospital stay, and health care costs. OBJECTIVE: The aim of this study is to assess the utility of a new technique for reducing postoperative ileus after protective ileostomy closure. DESIGN: This is a prospective randomized study registered at ClinicalTrials.gov (NCT01881594). Patients were randomly assigned to undergo either stimulation through the efferent limb of the ileostomy before surgery or nonstimulation before surgery. SETTING: This study was conducted at the Department of Surgery of the Virgen de la Arrixaca Clinical University Hospital (Murcia). PATIENTS: Seventy patients underwent surgery for ileostomy closure. In 35 patients, during the 2 weeks before surgery, daily stimulation of the defunctionalized stomal segment was performed by using a thick solution (500 mL of physiological saline associated with 30 g of thickening agent, Nestle Resource, Vevey, Switzerland). In the other 35 patients, stimulation was not performed before surgery. MAIN OUTCOME MEASURES: The primary outcome was postoperative ileus. The secondary outcomes included time to tolerating a diet and postoperative stay. RESULTS: Both groups of patients were homogenous for demographic data, characteristics of the first rectal cancer operation, and intersurgery periods. After ileostomy closure, the stimulated group of patients had an earlier return to oral tolerance (1.06 vs 2.57 days; p = 0.007) and passage of flatus or stool (1.14 vs 2.85 days; p <0.001) than the nonstimulated group of patients. The incidence of postoperative ileus (2.85% vs 20%; p = 0.024) and hospital stay (2.49 vs 4.61 days; p = 0.002) was also lower in the stimulated patients. LIMITATIONS: Small numbers of patients means that no definitive statements can be made regarding the effectiveness of this technique. CONCLUSIONS: Stimulation of the efferent limb of the ileostomy before closure is a safe technique that reduces postoperative ileus and fosters early intestinal transit and oral tolerance with a shorter postoperative hospital stay.


Assuntos
Ileostomia/efeitos adversos , Íleus , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Estimulação Química , Técnicas de Fechamento de Ferimentos/efeitos adversos , Idoso , Feminino , Motilidade Gastrointestinal , Humanos , Ileostomia/métodos , Íleo/efeitos dos fármacos , Íleo/fisiopatologia , Íleo/cirurgia , Íleus/etiologia , Íleus/fisiopatologia , Íleus/prevenção & controle , Absorção Intestinal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Excipientes Farmacêuticos/uso terapêutico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Cloreto de Sódio/uso terapêutico , Resultado do Tratamento
7.
Rev. Fac. Nac. Salud Pública ; 32(2): 17-25, mayo-ago. 2014.
Artigo em Espanhol | LILACS | ID: lil-724951

RESUMO

OBJETIVO: describir las prácticas durante el proceso de gestación en las comunidades Embera y Wounaan del departamento de Chocó. METODOLOGIA: se realizó un estudio cualitativo de tipo exploratorio, por medio de entrevistas en profundidad a mujeres indígenas gestantes, mujeres indígenas líderes en salud y hombres líderes y promotores de los pueblos Embera y Wounaan del departamento de Chocó, para un total de 19 entrevistas, y se utilizó el diseño metodológico de Taylor y Bogdan para el análisis de las mismas. RESULTADOS : las comunidades realizan unas prácticas durante la gestación enfocadas básicamente en los cuidados buscados por la pareja para la gestante, cuidados ofrecidos por la familia a la gestante, alimentación durante la gestación y actividades realizadas por la gestante. CONCLUSION:las comunidades Embera y Wounaan realizan diversas prácticas de cuidado alrededor de la gestación que propenden por la protección de la vida de la gestante y del bebé, es así como la pareja, la familia y la comunidad en algunos momentos acompañan a la mujer.


OBJECTIVE: to describe the care practices during pregnancy of the Embera and Wounaan communities from the Chocó department. METHODOLOGY: an exploratory qualitative study was carried out;data was collected through in-depth interviews with pregnant indigenous women, indigenous women who are health leaders in their communities and with men who are leaders and promoters among the Wounaan and Embera communities in the Chocó department.A total of 19 interviews were conducted and the Taylor & Bogdan methodological design was used to analyze them. RESULTS :the practices performed by these communities during pregnancy mainly involve the mother being taken care of by her partner and their family; they also involve a particulardiet during gestation as well assome activities of the mother. CONCLUSION:the Wounaan and Embera communities perform various care practices regarding pregnancy in order to protect the life of both the mother and her child. As a result of this, the partner, the family and, at times, the community support the mother.

8.
World J Surg ; 38(9): 2212-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24728536

RESUMO

BACKGROUND: Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons. METHODS: Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed. RESULTS: Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected. CONCLUSIONS: Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.


Assuntos
Anestesia Epidural , Países em Desenvolvimento , Bócio Endêmico/cirurgia , Instalações de Saúde , Tireoidectomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Epidural/efeitos adversos , Anestesia Geral , Camarões , Feminino , Humanos , Hipotireoidismo , Tempo de Internação , Masculino , Mali , Pessoa de Meia-Idade , Morbidade , Tireoidectomia/efeitos adversos , Adulto Jovem
9.
World J Surg ; 36(12): 2795-801, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22976790

RESUMO

BACKGROUND: Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was to evaluate the quality of hernia repair processes carried out by the Surgical Solidarity Charity in Central African States. MATERIALS AND METHODS: A total of 524 cases of inguinal hernia repair carried out in Cameroon and Mali during 2005 to 2009 were compared with 386 cases treated in a Multicentre Spanish Study (2003). General data (clinical, demographic, etc.), type of surgery, complications, and effectiveness and efficiency indicators were collected. RESULTS: Preoperative studies in the Spanish group were greater in number than in the African group. The use of local anesthesia was similar. Antibiotic prophylaxis was higher in the African group (100% to 75.4%). The use of mesh was similar. The incidence of hematomas was higher in the Spanish group (11.61% to 4.61%), but the incidence of infection of the wound and of hernia recurrence was similar, although follow-up was only carried out in 20.97% in the African group (70% in the Spanish group). Hospital stay of more than 24 h was higher in the Spanish group. CONCLUSIONS: The standard quality of surgery for the treatment of hernia in developing countries with few instrumental means, and in sub-optimal surgical conditions is similar to that provided in Spain.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/normas , Cooperação Internacional , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Camarões , Instituições de Caridade , Feminino , Seguimentos , Herniorrafia/instrumentação , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Mali , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Espanha , Telas Cirúrgicas/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
10.
Br J Surg ; 96(9): 982-9, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19644973

RESUMO

BACKGROUND: The laparoscopic treatment of rectal cancer is controversial. This study compared surgical outcomes after laparoscopic and open approaches for mid and low rectal cancers. METHODS: Some 204 patients with mid and low rectal adenocarcinomas were allocated randomly to open (103) or laparoscopic (101) surgery. The surgical team was the same for both procedures. Most patients had stage II or III disease, and received neoadjuvant therapy with oral capecitabine and 50-54 Gy external beam radiotherapy. RESULTS: Sphincter-preserving surgery was performed in 78.6 and 76.2 per cent of patients in the open and laparoscopic groups respectively. Blood loss was significantly greater for open surgery (P < 0.001) and operating time was significantly greater for laparoscopic surgery (P = 0.020), and return to diet and hospital stay were longer for open surgery. Complication rates, and involvement of circumferential and radial margins were similar for both procedures, but the number of isolated lymph nodes was greater in the laparoscopic group (mean 13.63 versus 11.57; P = 0.026). There were no differences in local recurrence, disease-free or overall survival. CONCLUSION: Laparoscopic surgery for rectal cancer has a similar complication rate to open surgery, with less blood loss, rapid intestinal recovery, shorter hospital stay, and no compromise of oncological outcomes.


Assuntos
Adenocarcinoma/cirurgia , Laparoscopia , Neoplasias Retais/cirurgia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/radioterapia , Idoso , Feminino , Humanos , Estimativa de Kaplan-Meier , Laparoscopia/efeitos adversos , Tempo de Internação , Excisão de Linfonodo , Metástase Linfática , Masculino , Terapia Neoadjuvante , Recidiva Local de Neoplasia/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Reoperação
11.
Rev Med Inst Mex Seguro Soc ; 46(3): 273-9, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-19133204

RESUMO

OBJECTIVE: to determine the relationship between the abdominal obesity and cardiovascular risk factors in apparently healthy subjects from Mexico City. METHODS: a total of 186 apparently healthy men and nonpregnant women from Mexico City, were enrolled in a cross-sectional study. A detailed medical history and physical examination were performed. Abdominal obesity was defined by waist circumference > or = 80 cm for women and > or = 90 cm for men. RESULTS: a total of 125 women (67.2 %) and 61 men (32.8 %) were enrolled. Of them, 151 (81.2 %) had insulin resistance and 130 (69.9 %) abdominal obesity. Among obese subjects 96 (46.2 %) showed metabolic syndrome. There were a high prevalence of hypertriglyceridemia (31 %) and low serum levels of HDL-cholesterol (58 %). CONCLUSIONS: the used cut point for abdominal obesity, despite identifying a high proportion of subjects with cardiovascular risk, did not recognize a high proportion of subjects with disorders in their lipid profile.


Assuntos
Gordura Abdominal , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Obesidade/complicações , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco
12.
Int J Colorectal Dis ; 18(6): 495-9, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14517686

RESUMO

BACKGROUND AND AIMS: Neoadjuvant radiation and chemotherapy in rectal cancer reduces local recurrences and increases the rate of conservative sphincter surgery. However, an increase in postoperative morbidity and mortality has also been observed. This study analyzed the operative difficulty and postoperative complications in patients with this treatment. PATIENTS AND METHODS: Retrospective review of 103 patients with rectal cancer, divided into two groups: group A, 53 patients undergoing preoperative radiotherapy with 45 Gy combined with chemotherapy, and group B, 50 patients with rectal cancer who received surgery after diagnosis. Both groups were homogeneous. The two groups were compared for both technical difficulty, using intraoperative data and rate of complications. RESULTS: There were no statistically significant differences between the two groups with regard to intraoperative or postoperative data. In group A there were 20 complications in 17 patients (32%) and in group B 22 complications in 19 patients (38%). The rates of perineal wound infection were similar. The percentage of anastomotic leaks was higher in group A. A greater number of anterior resections was performed in group A. CONCLUSION: Preoperative radiation and chemotherapy in rectal cancer does not increase postoperative complications and increases the rate of sphincter-preserving surgery.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Complicações Pós-Operatórias , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/radioterapia , Adulto , Idoso , Canal Anal/patologia , Canal Anal/cirurgia , Anastomose Cirúrgica , Quimioterapia Adjuvante/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Radioterapia Adjuvante/efeitos adversos , Neoplasias Retais/cirurgia , Reto/cirurgia , Estudos Retrospectivos
13.
Transplant Proc ; 35(5): 1832-3, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12962813

RESUMO

INTRODUCTION: In the majority of patients transplanted for unresectable liver metastases, long-term results are disappointing because of early tumor recurrence. Due to its biologically less aggressive nature, neuroendocrine metastases (NM) may represent a good indication for liver transplantation (LT). PATIENTS AND METHODS: Between January 1996 and May 2000, five patients with NM were transplanted. The primary tumors were located in the pancreas (n=4) and the small bowel (n=1). In three cases there were symptoms related to hormone production: two carcinoids, and one gastrinoma. The management of primary tumors was sequential in three patients with the tumor being resected before LT (one Whipple procedure and two left pancreatectomies). In two patients the resections of the primary tumors and the LT were simultaneous namely one bowel resection and one left pancreatectomy. All patients were treated with chemotherapy. RESULTS: Two patients developed recurrent disease succumbing at 15 months (nonfunctioning NE pancreatic head tumor) and 17 months (carcinoid of the pancreatic tail) post-LT. Another patient died at 3 months post-LT due to technical complications. The other two patients are alive and free of recurrence. CONCLUSION: Despite the promising results obtained with LT for NM, our experience indicates that patients must be carefully selected. Perhaps the use of more aggressive chemotherapeutic protocols combined with an individualized approach will improve the results.


Assuntos
Transplante de Fígado/fisiologia , Tumores Neuroendócrinos/cirurgia , Adulto , Evolução Fatal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Tumores Neuroendócrinos/patologia , Resultado do Tratamento
14.
Transplant Proc ; 35(5): 1852-4, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12962822

RESUMO

INTRODUCTION: For patients with fulminant hepatic failure who show a poor evolution despite medical treatment, liver transplantation is an option, with survival rates of greater than 50%. The ideal time to perform the transplant is controversial, as it must not be done too soon (when the liver disease is still reversible) or too late (when the patient is in an irreversible clinical situation). PATIENTS AND METHODS: Retrospective review of the clinical histories of 34 patients admitted to our hospital with a diagnosis of fulminant hepatic failure included 26 who underwent transplantation. The most frequent cause was viral (n=10, 38%); with no etiology established in 11 cases (42%). Thirteen patients had preoperative complications, the most frequent being renal insufficiency. As for degree of AB0/DR compatibility, 13 cases were identical (40%), 17 compatible (51%), and the other three incompatible (9%). RESULTS: Thirty-three transplants were performed in 26 patients: four were retransplants due to chronic rejection, two for primary graft failure, and one for hyperacute rejection. The overall mortality rate was 46% (12 patients). The most frequent cause of death was infection (50%). The overall actuarial survival rate was 68% at 1 year, 63% at 3 years, and 59% at 5 years. The factors associated with a poor prognosis were renal and respiratory insufficiency, a grade D electroencephalogram, and encephalopathy grades III and IV, the last being the only prognostic factor identified in the multivariate analysis. The prognostic factors for mortality were a grade D electroencephalogram, encephalopathy grades III and IV and respiratory insufficiency, the last being the only prognostic factor identified in the multivariate analysis. CONCLUSION: Good results of transplantation for the management of fulminant hepatic failure depends on optimal selection of transplant candidates, which means identifying them early, reducing the waiting time, and excluding factors associated with a poor prognosis.


Assuntos
Falência Hepática/cirurgia , Transplante de Fígado/fisiologia , Análise de Variância , Causas de Morte , Seguimentos , Humanos , Falência Hepática/etiologia , Falência Hepática/mortalidade , Estudos Retrospectivos , Espanha , Análise de Sobrevida , Fatores de Tempo
15.
Transplant Proc ; 35(5): 1915-7, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12962847

RESUMO

INTRODUCTION: Due to the technical experience acquired in the field of liver transplantation portal vein thrombosis is no longer considered a contraindication for transplantation. Nevertheless, the results obtained in patients with portal vein thrombosis are at times suboptimal, and there is no consensus on the appropriate surgical technique. PATIENTS AND METHODS: Among the 455 liver transplants performed between May 1988 and December 2001, 32 (7%) presented with portal vein thrombosis. Twenty (62%) were type Ib, seven (22%) type II/III, and five (16%) type IV. Twenty-two were men (69%), with a mean age of 50 years (range: 30-70 years); the thrombosis in all cases developed in a cirrhotic liver. The surgical method in all cases consisted of an eversion thromboendovenectomy under direct visual guidance, with occlusion of the portal flow using a Fogarty balloon. RESULTS: Among the 32 cases undergoing thrombectomy, 31 (96%) were successful with a failure in a case of type IV thrombosis, which was resolved by portal arterialization. Of the 31 successful cases, only one with type IV thrombosis rethrombosed. The 5-year survival rate of the patients in the series was 69%. Only two patients died from causes related to the thrombosis, both showing type IV thrombosis. CONCLUSION: The ideal treatment for portal thrombosis during liver transplantation depends on its extension and on the experience of the surgeon. In our experience, eversion thromboendovenectomy resolves most thromboses (types I, II, and III), but management of type IV, which occasionally can be treated with this technique, may require more complex procedures such as bypass, portal arterialization or cavoportal hemitransposition.


Assuntos
Complicações Intraoperatórias/cirurgia , Transplante de Fígado/efeitos adversos , Veia Porta/cirurgia , Trombose/cirurgia , Adulto , Idoso , Feminino , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/cirurgia , Masculino , Veias Mesentéricas/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
16.
Surg Endosc ; 16(12): 1658-62, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12140634

RESUMO

INTRODUCTION: Gastric bypass is one of the most commonly used surgical techniques for the management of morbid obesity. It is usually done as an open surgery procedure, and in recent years surgeons have begun to perform it via the laparoscopic approach. The aim of this paper is to describe our surgical technique for laparoscopic gastric bypass (LGBP) and present the short-term results. MATERIALS AND METHODS: Between January 2000 and January 2002 we operated on 50 patients with morbid obesity who met criteria for bariatric surgery. The patients had a mean age of 34 years and a body mass index (BMI) of 47. RESULTS: Conversion was necessary in 4 of the 50 patients (8%). Mean operating time was 181 min, with a difference of 60 min between the first 10 and last 10 cases. There was a 26% rate of complications, 14% of which were early (%<% 30 days) and 12% late (%>%30 days). Mean hospital stay was 4.5 days. CONCLUSION: LGBP is a technique with good short-term results as far as weight loss is concerned, although it has one of the most complex learning curves in laparoscopic surgery. Surgeons who regard gastric bypass as the technique of choice for the surgical management of morbid obesity should consider performing it via the laparoscopic approach.


Assuntos
Anastomose em-Y de Roux/métodos , Derivação Gástrica/métodos , Gastroplastia/métodos , Laparoscopia/métodos , Obesidade Mórbida/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Obesidade Mórbida/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Redução de Peso
19.
Transpl Int ; 13 Suppl 1: S171-3, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11111990

RESUMO

Familial amyloidotic polyneuropathy type I (FAP I) is a hereditary systemic amyloidosis usually involving the peripheral nervous system. In this paper we report our experience regarding the survival and the evolution of the sensory motor syndrome of the extremities and autonomic dysfunction in four siblings with the Ala-71 variant who were treated by liver transplantation (LT). The four siblings are alive 2-5 years after LT. After the operation, the seriated determinations of TTR-Ala-71 variant showed a constant decrease in serum levels in all cases. Our results support the proposal that LT should be indicated especially in forms with early clinical onset (3rd and 4th decades) and rapid progress to stop the neurological deterioration of the patients.


Assuntos
Neuropatias Amiloides/cirurgia , Transplante de Fígado , Pré-Albumina/genética , Adulto , Alanina , Neuropatias Amiloides/genética , Neuropatias Amiloides/fisiopatologia , Seguimentos , Variação Genética , Humanos , Transplante de Fígado/fisiologia , Núcleo Familiar , Fatores de Tempo
20.
Transplantation ; 70(7): 989-98, 2000 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-11045632

RESUMO

BACKGROUND: It is not known whether the pig liver is capable of functioning efficiently when transplanted into a primate, neither is there experience in transplanting a liver from a transgenic pigs expressing the human complement regulator human complement regulator decay accelerating factor (h-DAF) into a baboon. The objective of this study was to determine whether the porcine liver would support the metabolic functions of non-human primates and to establish the effect of hDAF expression in the prevention of hyperacute rejection of porcine livers transplanted into primates. METHODS: Five orthotopic liver xenotransplants from pig to baboon were carried out: three from unmodified pigs and two using livers from h-DAF transgenic pigs. FINDINGS: The three control animals transplanted with livers from unmodified pigs survived for less than 12 hr. Baboons transplanted with livers from h-DAF transgenic pigs survived for 4 and 8 days. Hyperacute rejection was not detected in the baboons transplanted with hDAF transgenic pig livers; however, it was demonstrated in the three transplants from unmodified pigs. Baboons transplanted with livers from h-DAF transgenic pigs were extubated at postoperative day 1 and were awake and able to eat and drink. In the recipients of hDAF transgenic pig livers the clotting parameters reached nearly normal levels at day 2 after transplantation and remained normal up to the end of the experiments. In these hDAF liver recipients, porcine fibrinogen was first detected in the baboon plasma 2 hr postreperfusion, and was present up to the end of the experiments. One animal was euthanized at day 8 after development of sepsis and coagulopathy, the other animal arrested at day 4, after an episode of vomiting and aspiration. The postmortem examination of the hDAF transgenic liver xenografts did not demonstrate rejection. INTERPRETATION: The livers from h-DAF transgenic pigs did not undergo hyperacute rejection after orthotopic xenotransplantation in baboons. When HAR is abrogated, the porcine liver maintains sufficient coagulation and protein levels in the baboon up to 8 days after OLT.


Assuntos
Antígenos CD55/farmacologia , Transplante de Fígado/imunologia , Transplante Heterólogo/imunologia , Transplante Heterólogo/fisiologia , Doença Aguda , Animais , Animais Geneticamente Modificados , Fatores de Coagulação Sanguínea/análise , Complemento C3/metabolismo , Complemento C4/metabolismo , Ensaio de Atividade Hemolítica de Complemento , Rejeição de Enxerto/prevenção & controle , Humanos , Fígado/patologia , Transplante de Fígado/mortalidade , Transplante de Fígado/patologia , Papio , Taxa de Sobrevida , Suínos , Fatores de Tempo
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