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1.
J Surg Res ; 303: 468-475, 2024 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-39426057

RESUMO

BACKGROUND: Despite major efforts in prevention, surgical site infections (SSIs) remain a burden on patients and the healthcare system and are associated with significant morbidity. SSIs are one of the costliest healthcare-associated infections. The diagnosis of SSIs is based mainly on clinical assessment, which may result in a delay in detection. The ability to detect SSIs in subclinical phase and initiate effective therapy earlier may reduce morbidity and hospital stay. In this study, we attempted to utilize long-wave infrared (LWIR) imaging to define the healing process of the surgical site and to detect abnormal healing. METHODS: In this prospective study, 50 patients undergoing elective abdominal surgery had LWIR images of their incision obtained at determined intervals from their operation to discharge. Images were processed with proprietary algorithms to create a thermal topograph used to define the healing process. RESULTS: Images of 45 patients were available for a final review. Of these 45 patients, 10 patients developed SSIs. Using the thermal topograph, 10 criteria for image analysis were defined, yielding a prediction of six out of the 10 SSIs and 35 out of the 35 normal healing wounds. Sensitivity was 60%, specificity was 100%, positive predictive value was 100%, and negative predictive value was 90.1%, with 92% accuracy. A preliminary program was created that allows trained users to methodically evaluate images providing them with a risk estimate. CONCLUSIONS: In this preliminary study, LWIR analysis of surgical wounds was able to identify normal and abnormal wound healing. Further large-scale studies are needed to validate results.

2.
Pediatr Emerg Care ; 28(7): 709-11, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22766592

RESUMO

A perforated peptic ulcer in a child is a rare entity. Severe abdominal pain in an ill-appearing child with a rigid abdomen and possibly with signs of shock is the typical presenting feature of this life-threatening complication of peptic ulcer disease. We present a case of a 14.5-year-old adolescent girl who developed abdominal and shoulder pain that resolved after 1 day. She was then completely well for 2 days until the abdominal and shoulder pain recurred. On examination, she appeared well, but in pain. A chest radiograph revealed a large pneumoperitoneum. She underwent emergent laparoscopic omental patch repair of a perforated ulcer on the anterior wall of her stomach. Result of a urea breath test to detect Helicobacter pylori was negative. The differential diagnosis of pneumoperitoneum in children is discussed, as are childhood perforated peptic ulcer in general, and the unique clinical features present in this case in particular.


Assuntos
Úlcera Péptica Perfurada/diagnóstico , Pneumoperitônio/etiologia , Dor Abdominal/etiologia , Adolescente , Diagnóstico Diferencial , Feminino , Infecções por Helicobacter/complicações , Helicobacter pylori , Humanos , Úlcera Péptica Perfurada/complicações , Úlcera Péptica Perfurada/cirurgia , Radiografia Torácica , Dor de Ombro/etiologia
3.
J Biomed Mater Res A ; 83(2): 414-22, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17455216

RESUMO

The aim of the present study was to evaluate the toxicity of biodegradable hydrogels in the rat with a future aim of utilizing this hydrogel as a vehicle for brachytherapy delivery in cancer patients. Two types of chitosan hydrogels: fast degrading and slow degrading; were prepared and surgically implanted in rats. The adjacent tissue response to the gels after subcutaneous and intraperitoneal implantation was examined histologically and found to be identical to typical foreign body response and was milder than the response to absorbable surgical sutures (Vicril). Neither tissue damage nor gel fragments could be detected in distant organs (brain, heart, lungs, liver, spleen, kidney, and sternal bone marrow) after implantation of the hydrogels. The degradation mechanism of the gels was studied in vivo, and it was deduced that an oxidative process degraded the chitosan. Loading the hydrogels with a radioisotope (131I-norcholesterol) caused a severe tissue response and necrosis in adjacent tissues only at a distance of several microns. It is concluded that crosslinked chitosan implants could serve as alternative, biocompatible, and safe biodegradable devices for radioisotope delivery in brachytherapy for cancer.


Assuntos
Materiais Biocompatíveis , Quitosana/farmacologia , Hidrogéis/farmacologia , Teste de Materiais , Peritônio/metabolismo , Implantação de Prótese , Pele/metabolismo , 19-Iodocolesterol/análogos & derivados , 19-Iodocolesterol/farmacologia , Animais , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Biomarcadores/metabolismo , Quitosana/administração & dosagem , Quitosana/química , Quitosana/toxicidade , Reagentes de Ligações Cruzadas/farmacologia , Reação a Corpo Estranho , Hidrogéis/administração & dosagem , Hidrogéis/toxicidade , Inflamação , Especificidade de Órgãos/efeitos dos fármacos , Peritônio/citologia , Peritônio/efeitos dos fármacos , Ratos , Pele/citologia , Pele/efeitos dos fármacos
4.
Harefuah ; 146(10): 745-6, 816, 2007 Oct.
Artigo em Hebraico | MEDLINE | ID: mdl-17990385

RESUMO

BACKGROUND: The approach for treating contralateral pediatric inguinal hernias is still controversial. The options are delaying surgery on the contralateral side, automatic exploration, diagnostic laparoscopy through the ipsilateral hernia sac or laparoscopic repair. In children younger than 6 months, occult bilateral hernia is more prevalent, and the hernia sac is difficult for laparoscopic manipulation. We present our early experience with transabdominal laparoscopic hernia repair in infants younger than 6 months of age. METHODS: Thirty four infants younger than 6 months and presenting with unilateral inguinal hernia were operated laparoscopically through a transabdominal approach. Patients were followed for a median of 11 months. RESULTS: Thirty three of the operations were completed laparoscopically. There was a 38.2% incidence of occult bilateral hernia. There were 3 recurrences due to a technical mistake (6.4%), one minor operative complication (needle lost and retrieved) and one minor anesthetic complication (prolonged intubation). In one operation a mini laparotomy was performed to retrieve a needle that was disengaged whilst removed from the abdomen. CONCLUSIONS: Laparoscopic hernia repair is feasible in young infants. It may be particularly suitable for children younger than 6 months. Further studies are needed to assess long-term results.


Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Seguimentos , Lateralidade Funcional , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
5.
J Control Release ; 111(3): 281-9, 2006 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-16499987

RESUMO

Compared with conventional external beam radiation, brachytherapy offers a superior therapeutic regimen. However, some major constraints are associated with its implementation, including the need of complicated procedures for device placement and removal. The purpose of this study was to examine whether crosslinked chitosan (Ct) implants could serve as potential biodegradable devices for brachytherapy. Ct was reacted with increasing amounts of glutaraldehyde to obtain hydrogels with different crosslinking densities, which were characterized chemically, thermally and mechanically. The effect of the dialysis medium conditions (ionic strength, osmolarity and pH) on the gel hydration and in vivo degradation was assessed. Two types of implants, slow and fast degrading gel (SDG and FDG, respectively), were prepared and implanted with or without Sudan Black (SB) in the rat. While SDG withstood for over a month, the FDG degraded within two weeks after implantation. The release kinetics of SB from the hydrogels verified their in vivo degradation properties. The incorporation of the radioactive compound (131)I-norcholesterol ((131)I-NC) into the SDG altered the degradation kinetics of the gel as reflected by the release kinetics of the radioactive marker. Eighty percent of (131)I-NC was released within a month after implantation, after which time, radioactivity was detected in the regional lymph nodes. Histological examination of the tissues surrounding the implants demonstrated negligible tissue response to the implants, when compared to biodegradable surgical sutures. It is concluded that hydrogels made of crosslinked Ct are potential novel, safe, degradable devices for brachytherapy.


Assuntos
Braquiterapia/métodos , Quitosana , Hidrogéis , 19-Iodocolesterol/análogos & derivados , Animais , Materiais Biocompatíveis/administração & dosagem , Reagentes de Ligações Cruzadas , Implantes de Medicamento , Glutaral , Radioisótopos do Iodo , Ratos
6.
J Control Release ; 123(2): 116-22, 2007 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-17854940

RESUMO

Brachytherapy has many potential roles in cancer therapy. However, major constraints are associated with placement and removal procedures of the brachytherapy machinery. An attractive approach would be the use of a biodegradable implant loaded with a radioisotope, thus enabling targeted radiotherapy, while reducing the need for surgical procedures for the removal of brachytherapy hardware. In this study, crosslinked chitosan (Ct) hydrogels were prepared and loaded with (131)I-norcholesterol ((131)I-NC). The radioactive hydrogels ((131)I-NC-Ct) were implanted adjacent to 4T1 cell-induced tumors in two different xenograft mice models either as primary therapy or surgical adjuvant therapy of breast cancer. Non-treated mice and mice implanted with naive (non-radioactive) hydrogels served as control groups. In the primary therapy model, the progression rate of the tumor was delayed by two weeks compared with the non-treated and the naive-implant control animals, resulting in a one-week extension in the survival of the treated animals. In the adjuvant therapy model, for the treatment of minimal residual disease, (131)I-NC-Ct implants were able to prevent 69% of tumor recurrence, and to prevent metastatic spread resulting in long-term survival, compared with 0% long-term survival of the non-treated and the naive control groups. Imaging of the hydrogel's in vivo elimination revealed a first order process with a half-life of 14 days. The degradation was caused by oxidation of the Ct as was assessed by in vitro H&E stain. Biodegradable radioactive implants are suggested as a novel platform for the delivery of brachytherapy. This radiotherapy regimen may prevent locoregional recurrence and metastatic spread after tumor resection.


Assuntos
19-Iodocolesterol/análogos & derivados , Implantes Absorvíveis , Braquiterapia/métodos , Quitosana/química , Neoplasias Mamárias Experimentais/radioterapia , 19-Iodocolesterol/administração & dosagem , 19-Iodocolesterol/química , Animais , Linhagem Celular Tumoral , Quitosana/metabolismo , Reagentes de Ligações Cruzadas/química , Feminino , Glutaral/química , Meia-Vida , Hidrogéis , Neoplasias Mamárias Experimentais/patologia , Neoplasias Mamárias Experimentais/cirurgia , Camundongos , Camundongos Endogâmicos BALB C , Modelos Biológicos , Metástase Neoplásica/prevenção & controle , Oxirredução , Radioterapia Adjuvante , Prevenção Secundária , Fatores de Tempo , Ensaios Antitumorais Modelo de Xenoenxerto
7.
J Pediatr Surg ; 41(6): e11-3, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16769321

RESUMO

We present the case of a premature baby who was born with the following conditions: an extensive atresia from the first part of the duodenum to the mid small bowel; malrotation of the distal part, in volvulus and in an "apple peel" configuration; no connection of the bile ducts to the bowel; and presence of a type II choledochal cyst. To our knowledge, this is the first case in which a combination of these anomalies is reported. A brief review of the relevant literature is also presented.


Assuntos
Anormalidades Múltiplas , Cisto do Colédoco/complicações , Obstrução Duodenal/congênito , Recém-Nascido Prematuro , Atresia Intestinal/complicações , Jejuno/anormalidades , Mesentério/anormalidades , Colecistectomia , Cisto do Colédoco/cirurgia , Obstrução Duodenal/cirurgia , Duodenostomia , Humanos , Recém-Nascido , Masculino
8.
J Pediatr Surg ; 41(7): 1335-7, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16818077

RESUMO

Imperforate anus and malrotation rarely occur together. The conjoint occurrence of these with Hirschsprung's disease is exceedingly rare, but failure to recognize its existence may lead to catastrophic results. We present a case in which awareness to this possibility caused early detection and avoidance of possible complications.


Assuntos
Anus Imperfurado/complicações , Doença de Hirschsprung/complicações , Anormalidades Múltiplas , Anus Imperfurado/cirurgia , Anormalidades do Sistema Digestório/complicações , Anormalidades do Sistema Digestório/cirurgia , Doença de Hirschsprung/cirurgia , Humanos , Recém-Nascido , Rim/anormalidades , Masculino
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