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1.
Surg Endosc ; 33(2): 620-632, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30167951

RESUMO

BACKGROUND: We aimed to assess the feasibility of a novel hybrid endoscopic/laparoscopic non-exposed, full-thickness, single-wall gastric resection technique guided by a fluorescence lymphangiography to identify the lymphatic pathway and the sentinel node basin. METHODS: Eight large white pigs (4 acute and 4 survival models) were included. Indocyanine green was injected submucosally around a pseudo-tumor at four points (1 ml, 0.1 mg/ml). The lymphatic spreading pathway was identified by the means of near-infrared (NIR) laparoscopic camera, and the resection line was planned outside of the fluorescent signals, to include all the potential lymphatic channels. Lymph node (LN) dissection was performed at greater curvature side and the infrapyloric area preserving the infragastric artery for all pigs. At the lesser curvature, 3-4 branches of the gastric artery were preserved in all acute and in two survival (group A), while in the remaining animals, 1-2 branches were preserved (group B). Perfusion of the remaining stomach was examined by NIR angiography. The gastric motility and function were evaluated by the means of a dynamic MRI immediately after the procedure and repeated after 1 week in surviving animals. RESULTS: The hybrid full-thickness resection with bilateral sentinel LN basin dissection were successfully performed with no intra-operative or post-operative complications. The removed specimen was including all the area with florescent signal. The remaining stomach demonstrated a good perfusion at the NIR angiography. The dynamic MRI revealed a preserved emptying function in the acute animals and in the group A, and a loss of function in the group B. CONCLUSIONS: Fluorescence-lymphangiography guided hybrid resection was feasible to remove a relatively large part of the stomach including the lymphatic spreading pathway and sentinel basin. The extent of dissection in the lesser curvature side can affect the post-operative function and further researches are warranted to optimize the concept.


Assuntos
Gastrectomia/métodos , Gastroscopia/métodos , Biópsia Guiada por Imagem/métodos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Linfografia/métodos , Linfonodo Sentinela , Cirurgia Assistida por Computador/métodos , Animais , Humanos , Modelos Anatômicos , Imagem Óptica/métodos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos , Suínos
2.
Surg Endosc ; 31(7): 2863-2871, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27796600

RESUMO

BACKGROUND: Augmented reality (AR) is the fusion of computer-generated and real-time images. AR can be used in surgery as a navigation tool, by creating a patient-specific virtual model through 3D software manipulation of DICOM imaging (e.g., CT scan). The virtual model can be superimposed to real-time images enabling transparency visualization of internal anatomy and accurate localization of tumors. However, the 3D model is rigid and does not take into account inner structures' deformations. We present a concept of automated AR registration, while the organs undergo deformation during surgical manipulation, based on finite element modeling (FEM) coupled with optical imaging of fluorescent surface fiducials. METHODS: Two 10 × 1 mm wires (pseudo-tumors) and six 10 × 0.9 mm fluorescent fiducials were placed in ex vivo porcine kidneys (n = 10). Biomechanical FEM-based models were generated from CT scan. Kidneys were deformed and the shape changes were identified by tracking the fiducials, using a near-infrared optical system. The changes were registered automatically with the virtual model, which was deformed accordingly. Accuracy of prediction of pseudo-tumors' location was evaluated with a CT scan in the deformed status (ground truth). In vivo: fluorescent fiducials were inserted under ultrasound guidance in the kidney of one pig, followed by a CT scan. The FEM-based virtual model was superimposed on laparoscopic images by automatic registration of the fiducials. RESULTS: Biomechanical models were successfully generated and accurately superimposed on optical images. The mean measured distance between the estimated tumor by biomechanical propagation and the scanned tumor (ground truth) was 0.84 ± 0.42 mm. All fiducials were successfully placed in in vivo kidney and well visualized in near-infrared mode enabling accurate automatic registration of the virtual model on the laparoscopic images. CONCLUSIONS: Our preliminary experiments showed the potential of a biomechanical model with fluorescent fiducials to propagate the deformation of solid organs' surface to their inner structures including tumors with good accuracy and automatized robust tracking.


Assuntos
Marcadores Fiduciais , Imageamento Tridimensional/métodos , Rim/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Realidade Virtual , Animais , Fenômenos Biomecânicos , Análise de Elementos Finitos , Corantes Fluorescentes , Técnicas In Vitro , Rim/diagnóstico por imagem , Laparoscopia , Modelos Anatômicos , Neoplasias/diagnóstico por imagem , Neoplasias/cirurgia , Suínos
3.
Surg Endosc ; 30(4): 1683-91, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26150225

RESUMO

BACKGROUND: Current surgical methods for partial gastric full-thickness resections (FTRs) are limited by long operative times and risk of gastric content spillage, especially for lesions located at the posterior wall. We propose a simplified hybrid approach to FTR with reduced risk of spillage. METHODS: Resection margins were marked by endoscopic electrocautery to simulate a gastric lesion in the upper third of the posterior wall in eight pigs. A custom-made laparoscopic "suture passer" was made of a sharpened bendable dissecting forceps. Full-thickness sutures were alternatively passed from the serosa side with the suture passer through the gastric wall and grabbed endoluminally using an endoscopic grasper and vice versa. These transgastric sutures formed either a purse string (PS; n = 4) or a continuous horizontal mattress (HM; n = 4). Sutures were then fastened from the laparoscopic side, resulting in external outpouching of the lesion. The pouch was transected using 45-mm linear staplers. Operative time, resection margins, and number of staplers were evaluated. RESULTS: The combined approach allowed one to precisely place the sutures around the pseudo lesions, despite the inflated stomach, and it included all target markings. PS and HM methods were similar regarding time for transgastric suture (780 s ± 219.1 s vs. 765 s ± 179.2 s, p = .885), resection margins (1.3 ± 1.0 cm vs. 0.8 ± 0.6 cm, p = .248), and number of staplers (3.8 ± 1.0 vs 3.3 ± 0.5, p = .405). Stapling time (600 s ± 189.7 s vs. 330 s ± 24.5 s, p = .028) was significantly shorter in the HM technique. CONCLUSION: FTR with laparo-endoscopic transgastric suture application was feasible in the animal model. This technique allows one to achieve accurate resection margins with minimal risk of spillage.


Assuntos
Gastrectomia/métodos , Gastroscopia/métodos , Laparoscopia/métodos , Neoplasias Gástricas/cirurgia , Animais , Feminino , Modelos Animais , Sus scrofa , Técnicas de Sutura , Suturas , Suínos
4.
Curr Opin Gastroenterol ; 31(5): 368-73, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26131923

RESUMO

PURPOSE OF REVIEW: This review covers the cause, evaluation and treatment options for gastroparesis. Symptoms of delayed gastric emptying are increasingly seen by gastroenterologists and gastrointestinal surgeons. Endoscopy - both laparoscopic and flexible - is increasingly important in treatment algorithms for this problem. RECENT FINDINGS: Gastroparesis is increasingly being seen in clinical practice. A progressive algorithm needs to be followed in these challenging cases: starting with medical treatment and diet modification, progressing through endoscopic treatments including new ones such as per-oral pyloromyotomy, and finally laparoscopic treatments including gastrectomy. SUMMARY: Endoscopic interventions are effective treatments for certain gastroparesis patients. New procedures offer a minimally invasive alternative to more radical options and should probably be more widely adopted.


Assuntos
Endoscopia Gastrointestinal , Gastroparesia/diagnóstico , Laparoscopia , Piloro/cirurgia , Dor Abdominal/etiologia , Algoritmos , Gastrectomia , Esvaziamento Gástrico , Gastroparesia/patologia , Gastroparesia/cirurgia , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Arch Physiother ; 13(1): 7, 2023 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-36967380

RESUMO

BACKGROUND: To translate and cross-culturally adapt into Brazilian-Portuguese, and to test the measurement properties of the following items of implementation outcome measures: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). METHODS: This was a measurement properties study in accordance with the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN). We conducted a translation and cross-cultural adaptation of three implementation measures according to guidelines for translation and cross-cultural adaptation, then we collected information from patients who had participated in remotely delivered physical therapy treatment for musculoskeletal condition. The patients answered the translated versions of the implementation outcome measures. The measurement properties of the three implementation outcome measures were collected in a test-retest assessment, with an interval of 7 to 14 days.. The measurement properties evaluated in this study were interpretability, measured using Ceiling and Floor Effects, reliability in test-retest evaluation, measured using Cronbach's Alpha Coefficient, internal consistency, measured using Intraclass Correlation Coefficient and construct validity, measured using Pearson Correlation. RESULTS: We included 104 participants (76 female). The average age of the sample was 56.8 (SD 14.8) years old. The items of implementation outcome measures (AIM, IAM, and FIM) showed 66.39%, 63.11%, and 63.93% of ceiling effects. The items of implementation outcome measures showed adequate internal consistency measured using Cronbach's Alpha Coefficient (AIM: 0.89, IAM: 0.91, FIM: 0.93) and values of Standard Error of Measurement between 5 and 10%, showing good measurement error. The results of AIM and IAM was classified as moderate reliability and the FIM as substantial reliability. In a total 96 correlations, > 75% of correlations met our prior hypothesis. CONCLUSION: The three Brazilian-Portuguese versions of items of implementation outcome measures had adequate internal consistency, measurement error and construct validity. The three implementation outcome measures showed moderate to substantial reliability values. The Ceiling Effect was observed in the three measures, showing maximum values ​​in more than 15% of the evaluations.

6.
Sci Data ; 10(1): 368, 2023 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-37286560

RESUMO

We report a dataset containing full-scale, 3D images of rock plugs augmented by petrophysical lab characterization data for application in digital rock and capillary network analysis. Specifically, we have acquired microscopically resolved tomography datasets of 18 cylindrical sandstone and carbonate rock samples having lengths of 25.4 mm and diameters of 9.5 mm. Based on the micro-tomography data, we have computed porosity-values for each imaged rock sample. For validating the computed porosity values with a complementary lab method, we have measured porosity for each rock sample by using standard petrophysical characterization techniques. Overall, the tomography-based porosity values agree with the measurement results obtained from the lab, with values ranging from 8% to 30%. In addition, we provide for each rock sample the experimental permeabilities, with values ranging from 0.4 mD to above 5D. This dataset will be essential for establishing, benchmarking, and referencing the relation between porosity and permeability of reservoir rock at pore scale.

7.
Ann Surg ; 256(1): 87-94, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22609842

RESUMO

OBJECTIVES: There is considerable discussion regarding "success" rates for laparoscopic antireflux surgery (LARS). We hypothesized that, in part, this was a reflection of the outcome variables used. We, therefore, defined 8 specific variables (within 3 categories) and assessed outcomes for each in a large cohort of patients. METHODS: Four hundred patients (208 women; median age 52 years old) who underwent LARS at the University of Washington from 1993 to 2008 were given a comprehensive questionnaire to assess various aspects of their outcomes from LARS. In addition, we analyzed all functional studies and all endoscopies performed in these patients in our institution, whether the patients had symptoms or not, and compared the findings to all available preoperative values. RESULTS: The median follow-up was 92 (6-175) months. CONCLUSIONS: The success or failure of LARS cannot be defined in a single domain. A comprehensive analysis of outcomes requires categorization that includes symptom response, side-effects, patient's perception and objective measurement of acid exposure, mucosal integrity, and the need for additional medical or surgical treatment. Only then can patients and physicians better understand the role of LARS and make informed decisions.


Assuntos
Refluxo Gastroesofágico/cirurgia , Esôfago de Barrett/complicações , Terapia Combinada , Progressão da Doença , Neoplasias Esofágicas/epidemiologia , Feminino , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/fisiopatologia , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Monitorização Ambulatorial , Inibidores da Bomba de Prótons/uso terapêutico , Reoperação , Resultado do Tratamento
8.
Braz J Phys Ther ; 26(6): 100464, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36410257

RESUMO

BACKGROUND: During the COVID-19 pandemic, telerehabilitation allowed the continuation of physical therapy care in parallel with public health measures to prevent the virus spread. However, in low- and middle-income countries including Brazil, telerehabilitation was unfamiliar to most of the population. OBJECTIVE: To investigate acceptability, preferences, and needs in telerehabilitation by Brazilian physical therapists and the general population. METHODS: We conducted an observational cross-sectional study with an online survey consisting of 13 multiple-choice items. Items were distributed among acceptability, preferences, and needs sections, and encompassed confidence in delivering or receiving telerehabilitation, its perceived efficacy and costs, and suitable content. RESULTS: A total of 1107 responses were registered, 717 from physical therapists. Half of them self-reported confidence in conducting telerehabilitation through the internet (synchronous or asynchronous). The same proportion disagreed that telerehabilitation is as effective as in-person interventions. Physical therapists agreed telerehabilitation should contain educational, self-management strategies, and exercises information, but the general population endorsed the provision of technical advice on exercise execution. The general population mostly reported that telerehabilitation could help their specific health condition (86%), but only 14% of respondents would pay the same as they pay for in-person consultations. Participants reported an overall preference for synchronous communication and concern about the lack of a hands-on approach. CONCLUSION: Physical therapists and the general population appear to demonstrate apprehension towards telerehabilitation. Insufficient preparation or inadequate knowledge might influence participants' acceptance, preferences, and needs.


Assuntos
COVID-19 , Fisioterapeutas , Telerreabilitação , Humanos , Estudos Transversais , Pandemias , Opinião Pública , Inquéritos e Questionários
11.
Surg Endosc ; 25(12): 3740-6, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21735327

RESUMO

BACKGROUND: Most epiphrenic diverticula traditionally have been approached through a left thoracotomy. Because laparoscopy provides excellent exposure to the distal esophagus and decreases the morbidity of thoracoscopy or thoracotomy, we have used it preferentially since 1997 and routinely since 2001. This study describes our experience with this approach. METHODS: From 1997 to 2008, 23 patients underwent surgery for epiphrenic diverticula at the University of Washington so that all patients are ≥2 years out. Our initial approach was via laparoscopy in 19 patients, VATS in 2, and open thoracotomy in 2. Details of the operation and postoperative course were recorded in our database. The patients were contacted by one of the investigators regarding current symptoms. RESULTS: The median age was 57 (range 23-83) years. The medium follow-up was 45 months. Eighteen patients had esophageal manometry at our institution; 12 of them were abnormal (66.67%). The median diameter of diverticula was 4 (range 2-10) cm. From the 19 patients approached by laparoscopy, there was one conversion to open thoracotomy in a patient with an associated leiomyoma. Both patients approached by VATS were converted to thoracotomy. Patients initially approached by laparoscopy had a median length of stay of 3 days. There was one contained esophageal leak. One patient died within 30 days from complications of the operation. Ninety-two percent of patients reported improvement of their dysphagia and 77% improvement of regurgitation. None of the patients developed recurrent diverticula. Eighty-five percent of the patients rated the results of the operation as good or excellent. CONCLUSIONS: Most epiphrenic diverticula can be treated successfully by using a laparoscopic approach. Morbidity and conversion rates are low and symptom control is excellent.


Assuntos
Divertículo Esofágico/cirurgia , Esofagoscopia/métodos , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
12.
Surg Endosc ; 25(10): 3448-52, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21556990

RESUMO

BACKGROUND: A reliable method for gastrotomy closure in NOTES will be essential for NOTES to become viable clinically. However, methods using existing and widely available endoscopic accessories have been ineffective. The objective of this study was to evaluate the feasibility and safety of a new simple method for gastric closure (retracted clip-assisted loop closure) that uses existing endoscopic accessories with minor modifications. METHODS: The retracted clip-assisted loop closure technique involves deploying 3-4 Resolution(®) clips (modified by attaching a 90-cm length of suture to the end of each clip) along the margin of the gastrotomy with one jaw on the serosal surface and the other jaw on the mucosal surface. The suture strings are threaded through an endoloop. Traction is then applied to the strings causing the gastric wall to tent. The endoloop is secured below the tip of the clips, completing a full-thickness gastrotomy closure. The main outcome measures were feasibility, efficacy, and safety of the new retracted clip-assisted loop closure technique for NOTES gastrotomy closure. RESULTS: An air-tight seal was achieved in 100% (n = 9) of stomachs. The mean leak pressure was 116.3 (±19.4) mmHg. CONCLUSIONS: The retracted clip-assisted loop closure technique can be used to perform NOTES gastrotomy closure by using existing endoscopic accessories with minor modifications.


Assuntos
Cirurgia Endoscópica por Orifício Natural/métodos , Estômago/cirurgia , Animais , Modelos Animais de Doenças , Estudos de Viabilidade , Cirurgia Endoscópica por Orifício Natural/instrumentação , Suínos
13.
Physiother Theory Pract ; 36(10): 1130-1136, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30474454

RESUMO

It has been postulated that the mechanical and neurophysiological effects induced by stretching decrease maximal muscle strength and power. Additionally, the reduction in neural input and muscle stiffness can affect the joint stabilization process. However, there is no evidence available to support this hypothesis. Thus, the aim of this study is to analyze the influence of static stretching on dynamic joint stability. Twenty physically active female university students (22.8 ± 5.3 years; 58 ± 8.8 kg; 1.62 ± 0.07 m) performed a series of static-passive stretching exercises for the peroneus longus and brevis muscles (four repetitions of 30 s). Before and after the stretches, electromyography was performed on both muscles during simulated ankle sprain. Mathematical algorithms calculate the latency and the electromyography activity (RMS). After stretching, the latency increased from 66ms to 73 ms (p = 0.003) for the peroneus brevis muscle and from 70 ms to 79 ms (p = 0.001) for the peroneus longus muscle. The RMS, calculated 100 ms after the simulation, decreased in the peroneus brevis muscle, from 25.05 to 18.16 (p = 0.001), and in the peroneus longus muscle, from 22.84 to 15.61 (p = 0.001). Muscle stretching changed the motor responses of both muscles. The increase in latency and the decrease in RMS indicate that static stretching influences the neuromuscular function involved in the joint stabilization process.


Assuntos
Articulação do Tornozelo/fisiologia , Exercícios de Alongamento Muscular/fisiologia , Músculo Esquelético/fisiologia , Adolescente , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Eletromiografia , Feminino , Humanos , Adulto Jovem
14.
Eur Oral Res ; 54(2): 69-76, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33474550

RESUMO

PURPOSE: This study aimed to evaluate if the contact of calcium hydroxide cements with polyacrylic and phosphoric acids would alter selected microscopic and physical and chemical properties. MATERIALS AND METHODS: Chemically activated (Hydro C and Dycal Advanced Formula II) and resin-modified photoactivated (Ultra-blend Plus) calcium hydroxide cements were examined after exposure to the following different strategies: contact with no substance (control group); rinsing with water and drying; contact with polyacrylic acid, rinsing with water, and drying; and contact with phosphoric acid, rinsing with water, and drying. Surface morphology, determined by scanning electron microscopy (SEM), water sorption and solubility, and the release of hydroxyl ions were evaluated. RESULTS: SEM showed a greater impact of the conditioning acids on the surface of the chemically activated cements. Ultra-blend Plus obtained the highest value of sorption (516.8 µg/mm3) and solubility (381.1 µg/mm3) and Hydro C had the lowest values 251.9 µg/mm3 and 206.3 µg/mm3 respectively. Considering the release of hydroxyl ions in comparison with time, Hydro C and Ultra-blend Plus presented significant statistical difference for polyacrylic and phosphoric acid subgroups. CONCLUSION: Hydro C and Dycal presented intensification of surface irregularities after contact with conditioning acids. The chemically activated materials suffered a decrease in sorption and solubility. The action of the conditioning acids promotes greater increase of the release of hydroxyl ions for Hydro C and Dycal.

15.
Biomaterials ; 261: 120306, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32871471

RESUMO

Rapidly expanding field of image-guided surgery needs new materials for near-infrared imaging with deep tissue penetration. Here, we introduce near-infrared coating of equipment (NICE) for image-guided surgery based on a series of lipophilic cyanine-7.5 dyes with bulky hydrophobic counterions and a biocompatible polymer, poly(methyl methacrylate). The NICE material exhibits superior brightness (15-20-fold higher) and photostability compared to fluorescent coatings based on commonly used indocyanine green (ICG). It can be deposited on different surfaces and devices, such as steel and gold fiducials, silicone and PVC catheters, polymeric surgical sutures and gauzes. Such coated medical devices show excellent stability in air and buffer for ≥150 days. Accelerated ageing revealed their shelf-life of ≥3 years. They are also stable in serum-containing media, whereas ICG-based coating shows rapid dye leakage. NICE is compatible with standard sterilization protocols based on ethylene oxide and vapor. Moreover, our coating material is biocompatible, where cultured cells spread effectively without signs of cytotoxicity. Ex vivo studies suggest that NICE on fiducials can be visualized as deep as 0.5 cm, and NICE on catheters enables their visualization inside ureters and esophagus. Finally, NICE on different medical devices has been validated for image-guided surgery in porcine and human cadaver models. Thus, the developed NIR coating material emerges as a powerful tool for a variety of medical applications.


Assuntos
Corantes Fluorescentes , Cirurgia Assistida por Computador , Animais , Humanos , Verde de Indocianina , Polímeros , Suínos
16.
Foot (Edinb) ; 40: 98-104, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31229793

RESUMO

Ankle sprain in plantarflexion and inversion is one of the most common injuries occurring in daily activities and sports. Although acute symptoms may resolve quickly, many individuals have reported persistent pain and instability. Thus, understanding the factors that contribute to the occurrence of this type of injury is extremely important. Although sprains are multifactorial, a relationship can be established between sprain and fatigue. Therefore, the present study examined the latency and intensity of activation of the peroneus longus and brevis muscles under conditions of fatigue. Twenty-three women participated in the study, including 12 with functional instability of the ankle and 11 without a history of sprain. To induce fatigue, the volunteers maintained the force of eversion and plantarflexion at 70% of the maximum voluntary isometric contraction for as long as possible until a 10% decline in the rated force occurred. Ten simulations of ankle sprains were performed before and after fatigue at random for each side, with simultaneous recordings of the electromyographic signals, using a simulator platform for inversion sprain and plantarflexion. As a result, after fatigue, no change in latency was observed. However, a reduction in the intensity of contraction of the muscles analyzed in both groups was observed. Neuromuscular control was concluded to be compromised in situations of fatigue, while differences in muscle behavior were not observed between stable and unstable ankles.


Assuntos
Traumatismos do Tornozelo/fisiopatologia , Instabilidade Articular/fisiopatologia , Fadiga Muscular/fisiologia , Entorses e Distensões/fisiopatologia , Adulto , Feminino , Humanos , Inquéritos e Questionários
17.
Int J Comput Assist Radiol Surg ; 12(3): 461-470, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27943043

RESUMO

PURPOSE: Locating the internal structures of an organ is a critical aspect of many surgical procedures. Minimally invasive surgery, associated with augmented reality techniques, offers the potential to visualize inner structures, allowing for improved analysis, depth perception or for supporting planning and decision systems. METHODS: Most of the current methods dealing with rigid or non-rigid augmented reality make the assumption that the topology of the organ is not modified. As surgery relies essentially on cutting and dissection of anatomical structures, such methods are limited to the early stages of the surgery. We solve this shortcoming with the introduction of a method for physics-based elastic registration using a single view from a monocular camera. Singularities caused by topological changes are detected and propagated to the preoperative model. This significantly improves the coherence between the actual laparoscopic view and the model and provides added value in terms of navigation and decision-making, e.g., by overlaying the internal structures of an organ on the laparoscopic view. RESULTS: Our real-time augmentation method is assessed on several scenarios, using synthetic objects and real organs. In all cases, the impact of our approach is demonstrated, both qualitatively and quantitatively ( http://www.open-cas.org/?q=PaulusIJCARS16 ). CONCLUSION: The presented approach tackles the challenge of localizing internal structures throughout a complete surgical procedure, even after surgical cuts. This information is crucial for surgeons to improve the outcome for their surgical procedure and avoid complications.


Assuntos
Percepção de Profundidade , Laparoscopia/métodos , Cirurgia Assistida por Computador/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Modelos Anatômicos
18.
Rev Bras Hematol Hemoter ; 39(1): 28-31, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28270342

RESUMO

INTRODUCTION: The clinical manifestations of sickle cell disease are related to the polymerization of hemoglobin S. The chronic hemolysis caused by this condition often causes the formation of gallstones that can migrate and block the common bile duct leading to acute abdomen. OBJECTIVE: This study aimed to evaluate the profile of patients with sickle cell disease and cholelithiasis. METHODS: Patients with sickle cell disease were separated into groups according to the presence or absence of cholelithiasis. Socioepidemiological and clinical characteristics, such as gender, age, use of hydroxyurea and the presence of other hemoglobinopathies were researched in the medical records of patients. RESULTS: A hundred and seven patients with sickle cell anemia were treated at the institution. Of these, 27 (25.2%) had cholelithiasis. The presence of cholelithiasis was higher in the 11-29 age group than in younger than 11 years and over 29 years. No association was found for the presence of cholelithiasis with gender, use of hydroxyurea or type of hemoglobinopathy (hemoglobin SS, hemoglobin SC or sickle beta-thalassemia). Sixteen of the patients had to be submitted to cholecystectomy with 14 of the surgeries being performed by laparoscopy. Complications were observed in three patients and one patient died for reasons unrelated to the surgery. CONCLUSION: A quarter of patients with sickle cell disease had gallstones, more commonly in the 11- to 29-year age range. Patients should be monitored from childhood to prevent cholelithiasis with preoperative, intra-operative and postoperative care being crucial to reduce the risk of complications in these patients.

19.
Arq Gastroenterol ; 43(3): 173-7, 2006.
Artigo em Português | MEDLINE | ID: mdl-17160230

RESUMO

BACKGROUND: Anatomic variations of the biliary tree are frequent and increase complications after liver transplantation. AIM: To describe the anatomy of the bile ducts of donors and recipients of living related liver transplantation. METHODS: From March 1998 to September 2002, the study was retrospective (23 transplantations). From October 2002 to August 2003, the study was prospective (17 transplantations). We studied the hepatic anatomy of 80 consecutive patients (40 donors and 40 recipients) of the living-related liver transplantation program of the "Hospital de Clínicas da Universidade Federal do Paraná" and the "Hospital Nossa Senhora das Graças", Curitiba, PR, Brazil; 51 were male (27 recipients 24 donors) and 29 female (13 recipients and 16 donors). The median age among the donors was 32.6 years and among the recipients was 36.3 years. Thirty-two recipients were adults and 8 recipients were under 15 years old. The bile duct anatomy was studied by magnetic resonance cholangiography in 33 patients, and anomalies were seen in 3 of them (9.1%). RESULTS: The most prevalent variation of bile ducts was the fusion of the right posterior duct with the left duct (6.06%; n=2). In the 40 harvesting operations, the right bile duct was single in 25 patients (87.5%), among the 32 right-lobe donors, double in 2 (6.25%) and triple in 2 (6.25%). All of the eight left livers procured had single bile ducts. Among the 40 recipients, the common bile duct was bifurcated in 2 of them (5%). CONCLUSION: The prevalence of biliary anomalies is high in patients subjected to living liver transplantation and some anomalies are not diagnosed with preoperative imaging exams.


Assuntos
Ductos Biliares/anatomia & histologia , Transplante de Fígado , Doadores Vivos , Adolescente , Adulto , Idoso , Ductos Biliares/anormalidades , Ductos Biliares/patologia , Atresia Biliar/diagnóstico , Criança , Pré-Escolar , Colangiopancreatografia por Ressonância Magnética , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos
20.
Biosci. j. (Online) ; 36(6): 1984-1989, 01-11-2020. tab
Artigo em Inglês | LILACS | ID: biblio-1148013

RESUMO

Brazil is currently the world's largest producer and exporter of sugarcane, and the crop has high socioeconomic importance in the country. Root-knot nematodes (Meloidogyne spp.) are one of the major limiting factors in sugarcane production. These plant parasites have wide geographic distribution, high damage potential, and are difficult to control. Recently, the species Meloidogyne enterolobii was identified in sugarcane crops in the state of Pernambuco, Brazil. Given the importance of genetic resistance for integrated nematode management and the lack of research on the M. enterolobii­sugarcane pathosystem, this study aimed to assess the response of sugarcane cultivars to M. enterolobii. Thirteen cultivars were evaluated for their resistance to M. enterolobii based on the nematode reproduction factor. The experiment was conducted in a greenhouse, in a completely randomized design, with 14 replicates. Pre-sprouted sugarcane seedlings were transplanted to 5 L pots, and each pot was considered an experimental unit. At 15 days after transplanting, the seedlings were inoculated with 5,000 eggs and second-stage juveniles of M. enterolobii. Tomato and okra plants were also inoculated to test the viability of the inoculum. At 240 days after inoculation, plant roots were processed and evaluated for nematode number. This parameter was used to calculate the nematode reproduction factor on each cultivar. All sugarcane cultivars were found to be immune to M. enterolobii, with a reproduction factor of 0.


O Brasil é atualmente o maior produtor e exportador mundial de cana-de-açúcar, tendo a cultura grande impacto socioeconômico no país. Dentre os diversos fatores que podem afetar sua produção se destacam os nematoides de galha (Meloidogyne spp.), por apresentarem ampla distribuição geográfica, alto potencial danoso e difícil controle. Recentemente a espécie Meloidogyne enterolobii foi identificada parasitando a cultura da cana-de-açúcar em Pernambuco. Dada à importância da resistência genética no manejo integrado de fitonematoides e a falta de trabalhos envolvendo o estudo desta espécie na cultura, o presente trabalho teve como objetivo avaliar a resposta de cultivares de cana-de-açúcar a M. enterolobii. Foram avaliadas 13 cultivares quanto a sua resistência a esta espécie com base no fator de reprodução do nematoide. O experimento foi conduzido em delineamento inteiramente casualizado, com 14 repetições, e mantido em casa de vegetação. Foram utilizadas mudas pré-brotadas de cana-de-açúcar, transplantadas para vasos de 5L, sendo cada vaso considerado uma unidade experimental. Cada unidade experimental foi inoculada com 5.000 ovos e juvenis de segundo estádio de M. enterolobii 15 dias após os transplantio. Plantas de tomateiro e quiabeiro também foram inoculadas para atestar a viabilidade do inoculo utilizado no experimento. Decorridos 240 dias da inoculação as raízes foram processadas para obtenção da população final e cálculo do fator de reprodução do nematoide de cada tratamento. Todas as cultivares de cana-de-açúcar avaliadas foram resistentes/imunes à M, enterolobii, apresentando fator de reprodução igual a zero.


Assuntos
Tylenchoidea , Saccharum
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