ABSTRACT
BACKGROUND: The effects of hernia repair on testicular function remain uncertain, regardless of the technique used. Studies that analyze testicular volume and flow after hernia repair or hormonal measurements are scarce and show contradictory results. This study aimed to evaluate the impact of bilateral inguinal hernia repair on male fertility in surgical patients in whom the Lichtenstein and laparoscopic transabdominal preperitoneal (TAPP) techniques were used. METHODS: A randomized clinical trial comparing open (Lichtenstein) versus laparoscopic (TAPP) hernia repair using polypropylene mesh was performed in 48 adult patients (20 to 60 years old) with primary bilateral inguinal hernia. Patients were evaluated preoperatively and 90 and 180 postoperative (PO) days. Sex hormones (Testosterone, FSH, LH and SHGB) analysis, testicular ultrasonography, semen quality sexual activity changes and quality of life (QoL) were performed. Postoperative pain was evaluated using the visual analog scale (VAS). RESULTS: Thirty-seven patients with aged of 44 ± 11 years were included, 19 operated on Lichtenstein and 18 operated on TAPP. The surgical time was similar between techniques. The pain was greater in the Lichtenstein group on the 7th PO day. The biochemical and hormonal analyses, testicular ultrasonography (Doppler, testicular volume, and morphological findings) and sperm quality were similar between groups. However, the sperm morphology was better in the Lichtenstein group after 180 days (p < 0.05 vs. preoperative) and two patients who underwent Lichtenstein hernia repair had oligospermia after 180 days. The QoL evaluation showed a significant improvement after surgery in the following domains: physical function, role emotional, bodily pain and general health (p < 0.05). On comparison of Lichtenstein vs. TAPP none of the domains showed statistically significant differences. No patient reported sexual changes. CONCLUSION: Bilateral inguinal hernia repair with polypropylene mesh, whether using Lichtenstein or TAPP, does not impair male fertility in terms of long-term outcomes. TRIAL REGISTRATION: Approved by the Ethics Committee for the Analysis of Research Projects (CAPPesq) of the HC/FMUSP, Number 2.974.457, in June 2015, Registered on Plataforma Brasil in October 2015 under Protocol 45535015.4.0000.0068. Registered on Clinicaltrials.gov, NCT05799742. Enrollment of the first subject in January 2016.
Subject(s)
Hernia, Inguinal , Laparoscopy , Adult , Humans , Male , Middle Aged , Young Adult , Fertility , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Laparoscopy/methods , Pain, Postoperative/surgery , Polypropylenes , Quality of Life , Semen , Semen Analysis , Surgical Mesh , Treatment OutcomeABSTRACT
PURPOSE: The use of synthetic mesh to repair infected abdominal wall defects remains controversial. Polyvinylidene fluoride (PVDF) mesh was introduced in 2002 as an alternative to polypropylene, with the advantages of improved biostability, lowered bending stiffness, and minimum tissue response. This study aimed to evaluate the short-term outcomes of using PVDF mesh to treat infected abdominal wall defects in the elective setting. METHODS: This prospective clinical trial started in 2016 and was designed to evaluate the short- and mid-term outcomes of 38 patients submitted to abdominal wall reconstruction in the setting of active mesh infection and/or enteric fistulas (AI) when compared to a group of 38 patients submitted to clean ventral hernia repairs (CC). Patients were submitted to single-staged repairs, using onlay PVDF mesh (DynaMeshÂź-CICAT) reinforcement to treat their defects. RESULTS: Groups had comparable demographic characteristics. The AI group had more previous abdominal operations and required a longer operative and anesthesia time. At 30Â days, surgical site occurrences were observed in 16 (42.1%) AI vs. 17 (44.7%) CC, p = 0.817; surgical site infection occurred in 4 (10.5%) AI vs. 6 (15.8%) CC, p = 0.497; and a higher number of procedural interventions were required in the CC group, 15.8 AI vs. 28.9% CC, p = 0.169. Both groups did not have chronic infections at 1Â year of follow-up, and one hernia recurrence was observed in the AI group. CONCLUSIONS: The use of PVDF mesh in the infected setting presented favorable results with a low incidence of wound infection.
Subject(s)
Abdominal Wall , Hernia, Ventral , Humans , Surgical Mesh , Abdominal Wall/surgery , Treatment Outcome , Hernia, Ventral/surgery , Herniorrhaphy/adverse effects , Herniorrhaphy/methods , Recurrence , Retrospective StudiesABSTRACT
BACKGROUND: The present clinical trial was designed to compare the results of bilateral inguinal hernia repair between patients who underwent the conventional Stoppa technique and laparoscopic total extraperitoneal repair (LTE) with a single mesh and without staple fixation. PATIENTS AND METHODS: This controlled, randomised clinical trial was conducted at General Surgery and Trauma of the Clinics Hospital, Medical School, the University of São Paulo between September 2010 and February 2011. Totally, 50 male patients, with a bilateral inguinal hernia, older than 25 years were considered eligible for the study. The following parameters were analysed during the early post-operative period: (1) The intensity of surgical trauma, operation time, C-reactive protein (CRP) levels, white blood cell count, bleeding and pain intensity; (2) quality of life assessment; and (3) post-operative complications. RESULTS: LTE procedure was longer than the Stoppa procedure (134.6 min ± 38.3 vs. 90.6 min ± 41.3; P < 0.05). The levels of CRP were higher in the Stoppa group (P < 0.05) but the number of leucocytes, haematocrit, and haemoglobin were similar between the groups (P > 0.05). There was no difference in pain during the 1st and 7th post-operative, physical functioning, physical limitation, the impact of pain on daily activities, and the Carolinas Comfort Scale during the 7th and 15th post-operative (P > 0.05). Complications occurred in 88% of Stoppa group (22 patients) and 64% in LTE group (16 patients) (P < 0.05). CONCLUSION: The comparative study between the Stoppa and LTE approaches for the bilateral inguinal hernia repair demonstrated that: (1) The LTE approach showed less surgical trauma despite the longer operation time; (2) Quality of life during the early post-operative period were similar; and (3) Complication rates were higher in the Stoppa group.
ABSTRACT
PURPOSE: To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. METHODS: Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh - cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. RESULTS: The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). CONCLUSION: Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.
Subject(s)
Foreign-Body Reaction/pathology , Inguinal Canal/surgery , Surgical Mesh , Vas Deferens/pathology , Animals , Foreign-Body Reaction/blood , Male , Models, Animal , Organ Size , Polypropylenes , Postoperative Period , Rats, Wistar , Spermatic Cord/surgery , Testis/anatomy & histology , Testosterone/blood , Vas Deferens/surgeryABSTRACT
Obstructive jaundice as an initial manifestation of uterine cancer is extremely rare. We present a case of a 72-year-old female who presented with obstructive jaundice, supposedly for pancreatic cancer. After detailed diagnostic investigation, the cause of the jaundice was attributed to a metastatic compression of the common bile duct, from the primary neoplasm of the uterus. This case highlights the importance of including uterine cancer in the differential diagnosis of woman presenting with obstructive jaundice, even though it is very rare.
ABSTRACT
INTRODUCTION: The management of chronic mesh infection is challenging and controversial. The use of synthetic material to repair the abdominal wall in the infected setting is not recommended, especially in the presence of active infection caused by Staphylococcus aureus. METHODS: This is a prospective observational study designed to evaluate the outcomes in patients with active mesh infection caused by Staphylococcus aureus. Patients underwent simultaneous removal and replacement of polypropylene mesh. The treatment protocol included the complete removal of infected mesh, followed by the anatomical reconstruction, and reinforcement of the abdominal wall using a new onlay polypropylene mesh. Early and late wound complications, medical complications, and hernia recurrences were analyzed. RESULTS: From 2006 until 2014, 22 patients with a mean age of 57.2 years and mean BMI of 29,3Â kg/m2 were studied. Sinuses were present in 21 patients. A recurrent ventral hernia was observed in 14 patients; two patients required a complex abdominal wall reconstruction due to enteric fistulas. Bowel resections or other potentially contaminated procedures were associated in 10 patients. Fourteen patients (63.6%) had an uneventful postoperative course; 5 (22.7%) patients had wound infections requiring debridement and three required partial (2) or total (1) mesh removal. Two patients died due to medical complications. Adverse results on long-term follow-up included one hernia recurrence after complete mesh removal and one persistent sinus after partial mesh removal requiring a reoperation to remove mesh remnants. All of the patients were considered free of infection after a mean follow-up of 44 months. CONCLUSIONS: Synthetic mesh replacement in patients with active Staphylococcus aureus infection has an acceptable incidence of postoperative wound infection and prevents hernia recurrence. Large-pore polypropylene mesh is a suitable material to be used in the infected surgical field as an onlay graft.
Subject(s)
Hernia, Ventral/surgery , Staphylococcal Infections/complications , Staphylococcus aureus , Surgical Mesh , Abdominal Wall/surgery , Adult , Aged , Chronic Disease , Contraindications , Debridement , Device Removal/methods , Female , Humans , Male , Middle Aged , Polypropylenes , Prospective Studies , Prosthesis-Related Infections/surgery , Recurrence , Reoperation/methods , Staphylococcal Infections/surgery , Surgical Mesh/adverse effects , Surgical Mesh/microbiology , Surgical Wound Infection/etiology , Surgical Wound Infection/surgery , Treatment Outcome , Wound Healing , Young AdultABSTRACT
OBJECTIVE: to present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.
Subject(s)
Abdominal Wound Closure Techniques/instrumentation , Sepsis/surgery , Surgical Mesh , Adolescent , Adult , Aged , Female , Hospital Mortality , Humans , Male , Middle Aged , Reoperation , Sepsis/mortality , Time Factors , Young AdultABSTRACT
INTRODUCTION: Venous aneurysms are unusual clinical entities that might be difficult to diagnose and usually appear as an asymptomatic incidental finding on physical examination or imaging study and discovered only during the surgical exploration. They are important differential diagnosis of groin and other subcutaneous mass. PRESENTATION OF CASE: We report a case of a 67-years-old woman who had a groin mass misdiagnosed as femoral hernia, which was subsequently diagnose as great saphena vein aneurysm in the intraoperative set and treated with ligature and resection. DISCUSSION: In conclusion, venous aneurysms of the superficial system are lesions that are important differential diagnosis of groin and other subcutaneous mass. CONCLUSION: Diagnosis is readily available by duplex ultrasonography; however, in most cases, the diagnosis is done only in the operative field.
ABSTRACT
PURPOSE: To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. METHODS: Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro(r) mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. RESULTS: No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). CONCLUSION: There is no difference between polypropylene (high-density) and Ultrapro(r) (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications.
Subject(s)
Dioxanes/therapeutic use , Hernia, Ventral/surgery , Herniorrhaphy/methods , Polyesters/therapeutic use , Polypropylenes/therapeutic use , Surgical Mesh , Animals , Hernia, Ventral/pathology , Herniorrhaphy/adverse effects , Male , Materials Testing , Rats, Wistar , Reproducibility of Results , Time Factors , Tissue Adhesions , Treatment OutcomeABSTRACT
OBJECTIVE: To present our experience with scheduled reoperations in 15 patients with intra-abdominal sepsis. METHODS: we have applied a more effective technique consisting of temporary abdominal closure with a nylon mesh sheet containing a zipper. We performed reoperations in the operating room under general anesthesia at an average interval of 84 hours. The revision consisted of debridement of necrotic material and vigorous lavage of the involved peritoneal area. The mean age of patients was 38.7 years (range, 15 to 72 years); 11 patients were male, and four were female. RESULTS: forty percent of infections were due to necrotizing pancreatitis. Sixty percent were due to perforation of the intestinal viscus secondary to inflammation, vascular occlusion or trauma. We performed a total of 48 reoperations, an average of 3.2 surgeries per patient. The mesh-zipper device was left in place for an average of 13 days. An intestinal ostomy was present adjacent to the zipper in four patients and did not present a problem for patient management. Mortality was 26.6%. No fistulas resulted from this technique. When intra-abdominal disease was under control, the mesh-zipper device was removed, and the fascia was closed in all patients. In three patients, the wound was closed primarily, and in 12 it was allowed to close by secondary intent. Two patients developed hernia; one was incisional and one was in the drain incision. CONCLUSION: the planned reoperation for manual lavage and debridement of the abdomen through a nylon mesh-zipper combination was rapid, simple, and well-tolerated. It permitted effective management of severe septic peritonitis, easy wound care and primary closure of the abdominal wall.
OBJETIVO: Apresentar nossa experiĂȘncia com reoperaçÔes agendadas em 15 pacientes com sepse intra-abdominal. MĂTODOS: foi empregada uma tĂ©cnica mais eficaz que consiste em fechamento abdominal temporĂĄrio com uma folha de malha de nylon contendo um zĂper. Realizamos as reoperaçÔes no centro cirĂșrgico, sob anestesia geral, com um intervalo mĂ©dio de 84 horas. A revisĂŁo consistiu de desbridamento de material necrosado e lavagem vigorosa da ĂĄrea peritoneal envolvida. A mĂ©dia de idade dos pacientes foi 38,7 anos; 11 pacientes eram do sexo masculino e quatro do sexo feminino. RESULTADOS: Quarenta por cento das infecçÔes foram devido Ă pancreatite necrosante. Sessenta por cento foram ocasionadas por perfuração intestinal secundĂĄria Ă inflamação, oclusĂŁo vascular ou trauma. Foram realizadas 48 reoperaçÔes, mĂ©dia de 3,2 operaçÔes por paciente. O dispositivo tela-zĂper foi deixado no local por uma mĂ©dia de 13 dias. Um estoma intestinal estava presente ao lado do zĂper em quatro pacientes e nĂŁo ocasionou complicação para o paciente. A mortalidade foi 26,6%. Nenhuma fĂstula resultou dessa tĂ©cnica. Quando a doença intra-abdominal estava sob controle, o dispositivo de fecho do tipo de rede foi removido, e a fĂĄscia foi fechada em todos os pacientes. Em trĂȘs pacientes, a ferida foi fechada primariamente, em 12 permitiu-se fechar por intenção secundĂĄria. Dois pacientes desenvolveram hĂ©rnia: uma incisional e outra na incisĂŁo de drenagem. CONCLUSĂO: A nova operação prevista para lavagem manual e desbridamento do abdĂŽmen atravĂ©s de uma combinação de tela-zĂper em nylon foi rĂĄpida, simples e bem tolerada, permitindo uma gestĂŁo eficaz da peritonite sĂ©ptica grave, fĂĄcil tratamento das feridas e fechamento primĂĄrio da parede abdominal.
Subject(s)
Humans , Abdominal Abscess , Abdominal Wall , General Surgery , Peritonitis , SepsisABSTRACT
PURPOSE: To compare the inflammatory response of three different meshes on abdominal hernia repair in an experimental model of incisional hernia. METHODS: Median fascial incision and skin synthesis was performed on 30 Wistar rats. After 21 days, abdominal hernia developed was corrected as follows: 1) No mesh; 2) Polypropylene mesh; and, 3) Ultrapro(r) mesh. After 21 days, the mesh and surrounding tissue were submitted to macroscopic (presence of adhesions, mesh retraction), microscopic analysis to identify and quantify the inflammatory and fibrotic response using a score based on a predefined scale of 0-3 degrees, evaluating infiltration of macrophages, giant cells, neutrophils and lymphocytes. RESULTS: No significant difference was seen among groups in adherences, fibrosis, giant cells, macrophages, neutrophils or lymphocytes (p>0.05). Mesh shrinkage was observed in all groups, but also no difference was observed between polypropylene and Ultrapro mesh (7.0±9.9 vs. 7.4±10.1, respectively, p=0.967). Post-operatory complications included fistula, abscess, dehiscence, serohematic collection and reherniation, but with no difference among groups (p=0.363). CONCLUSION: There is no difference between polypropylene (high-density) and Ultrapro(r) (low-density) meshes at 21 days after surgery in extraperitoneal use in rats, comparing inflammatory response, mesh shortening, adhesions or complications. .
Subject(s)
Animals , Male , Dioxanes/therapeutic use , Hernia, Ventral/surgery , Herniorrhaphy/methods , Polyesters/therapeutic use , Polypropylenes/therapeutic use , Surgical Mesh , Hernia, Ventral/pathology , Herniorrhaphy/adverse effects , Materials Testing , Rats, Wistar , Reproducibility of Results , Time Factors , Tissue Adhesions , Treatment OutcomeABSTRACT
INTRODUCTION: Infected incisional hernias are common in kidney transplant patients. Treating them in immunosuppressed patients can take months, increasing costs and implying loss of working productivity. Abdominal wall prostheses have not been used in infected immunosuppressed patients because of poor infection control. We evaluated the outcome of the surgical treatment of these patients with polypropylene mesh to shorten the hospitalization time and patient recovery. The records of 462 consecutive kidney transplant patients (March 2000 to February 2004) were reviewed. Of these 462 patients, 13 (2.8%) had infected or contaminated herniations at the transplant incision. They developed between 2 and 60 days (mean 14) after transplantation. The racial distribution was not significant, but herniations were more common in patients from cadaveric donors (4.5% versus 0%, P = 0.005). Predisposing factors were found in 6 patients (46.2%) and included complications from transplant surgery in 2, obesity in 1, leukopenia in 3, sepsis in 1, diabetes mellitus in 1, and wall weakness in 1 patient (3 had more than one risk factor). TECHNICAL CONSIDERATIONS: A prospective protocol of surgical correction with polypropylene mesh was established. After wound cleansing with normal saline, repair was done by primary fascial approximation and polypropylene mesh reinforcement. Broad-spectrum antibiotics and large-bore drains were used. Follow-up ranged from 1 to 40 months (mean 14.5). All patients did well except for one recurrence, 14 months after correction. CONCLUSIONS: Surgical repair with polypropylene mesh is safe and effective in treating infected or contaminated herniations in kidney transplant patients, with an acceptable (9.1%) incidence of recurrence.
Subject(s)
Hernia, Abdominal/etiology , Hernia, Abdominal/surgery , Kidney Transplantation/adverse effects , Polypropylenes , Surgical Mesh , Surgical Wound Infection/etiology , Surgical Wound Infection/surgery , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Incidence , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/surgery , Prospective Studies , Surgical Mesh/adverse effectsABSTRACT
O emprego de nutriçÀo parenteral no prĂ©-operatĂłrio de doentes com cĂąncer tem sido intensamente questionado. A nutriçÀo parenteral Ă© efetiva em reverter deficiĂȘncias, no entanto no cĂąncer os resultados nem sempre sĂ€o os desejados, alĂ©m de representar terapĂȘutica que nĂ€o estĂĄ isenta de riscos e Ă© de custo elevado. A divergĂȘncia dos resultados obtidos na literatura Ă© explicada pela falta de critĂ©rios na seleçÀo dos doentes, neoplasias em fases diferentes de evoluçÀo, perĂodos variĂĄveis de duraçÀo da terapĂȘutica nutricional e distintos graus de comprometimento nutricional. Uma revisĂ€o crĂtica mostra que muitos trabalhos falham em mostrar efeitos benĂ©ficos na nutriçÀo prĂ©-operatĂłria e o seu uso rotineiro em doentes nĂ€o selecionados, nĂ€o estĂĄ justificado. Este artigo procura rever a validade da nutriçÀo parenteral prĂ©-operatĂłria no doente com cĂąncer e qual o perĂodo mĂnimo para que seja efetiva.
Subject(s)
Humans , Nutritional Status , Neoplasms/diet therapy , Nutrition Disorders , Preoperative Care , Parenteral NutritionABSTRACT
O acometimento cardĂaco na tuberculose Ă© pouco freqĂŒente devido a uma provĂĄvel resistĂȘncia natural do miocĂĄrdio a infecçÀo pelo Mycobacterium tuberculosis. SĂ€o descritas quatro formas de doença no coraçÀo: nodular, difusa infiltrativa e miocardite intesticial inespecĂfica. As vias de contaminaçÀo do miocĂĄrdio sĂ€o a disseminaçÀo hematogĂȘnica, a drenagem linfĂĄtica retrĂłgrada a partir de linfonodos mediastinais contaminados e a infecçÀo por contiguidade direta com o pericĂĄrdio. A ausĂȘncia de sintomatologia clĂnica especĂfica e a dificuldade na identificaçÀo de bacilos ĂĄlcool-resistentes tornam dificil o diagnĂłstico clĂnico, contribuindo para a evoluçÀo desfavorĂĄvel na maioria dos casos. Os autores apresentam um caso de tuberculose do miocĂĄrdio com acometimento valvar, em doente jovem do sexo feminino tratada cirurgicamente e atualmente no sexto mĂȘs de acompanhamento
Subject(s)
Humans , Female , Adult , Tuberculosis, Cardiovascular/diagnosis , Myocarditis/diagnosis , Tuberculosis, Cardiovascular/surgery , Tuberculosis, Cardiovascular/pathology , Echocardiography , Follow-Up Studies , Myocarditis/surgery , Myocarditis/pathology , Postoperative ComplicationsABSTRACT
A ocorrĂȘncia de falĂȘncias orgĂąnicas no doente cirĂșrgico tem sido amplamente reconhecida, especialmente na vigĂȘncia de complicaçöes infecciosas pĂłs-operatĂłrias. Embora o exato mecanismo desencadeante seja desconhecido, a infecçÀo Ă© a variĂĄvel clĂnica mais importante na instalaçÀo da insuficiĂȘncia de mĂșltiplos ĂłrgĂ€os, principalmente a partir de foco intra-peritoneal. A açÀo das endotoxinas, os distĂșrbios metabĂłlicos caracterĂsticos da sepse e a produçÀo de inĂșmeros mediadores humorais, parecem ser os principais fatores etiopatogĂȘnicos capazes de alterar a microcirculaçÀo, produzindo hipoperfusĂ€o tecidual, lesĂ€o celular irreversivel e falĂȘncia de mĂșltiplos ĂłrgĂ€os e sistemas. Os autores fazem uma revisĂ€o dos mecanismos fisiopatolĂłgicos da sepse capazes de determinar falĂȘncia orgĂąnica, discutindo sua repercussĂ€o na microcirculaçÀo e destacando a açÀo dos principais mediadores humorais envolvido, ditos mediadores da falĂȘncia orgĂąnica
Subject(s)
Humans , Bacterial Infections , Multiple Organ Failure , Postoperative ComplicationsABSTRACT
A remoçÀo do fator causal sempre que possĂvel, a restauraçÀo precoce das estruturas lesada e a limpeza da cavidade, consistem a base do tratamento das peritonites agudas. A instituiçÀo de terapĂȘutica medicamentosa adequada e o emprego de medidas de suporte devem ser associados quando houver necessidade. Diversas sĂ€o as maneiras de se tentar o controle da infecçÀo peritoneal, compreendendo desde a simples intra-operatĂłria, atĂ© o desbridamento radical, sendo consenso geral a necessidade de lavagem da cavidade abdominal com soluçÀo salina. A laparostomia com reoperaçöes programadas constitui uma alternativa e deve ser empregadas em casos selecionados. A utilizaçÀo de substĂąncias coadjuvantes tĂłpicas associadas ao fluido de irrigaçÀo peritoneal, como os antibiĂłticos, antissĂ©pticos, imunoestimulantes, heparina, agentes fibrinolĂticos e outras, seja durante o ato operatĂłrio, constitui-se aspecto controverso, nĂ€o existindo estudos conclusivos a respeito. Os autores fazem uma revisĂ€o do tratamento cirĂșrgico da peritonite aguda, procurando discutir os principais mĂ©todos de limpeza da cavidade e o papel dos agentes farmacolĂłgicos intra-peritoneais no combate Ă infecçÀo
Subject(s)
Humans , Peritoneal Cavity/microbiology , Peritoneal Lavage , Peritonitis/surgery , Anti-Bacterial Agents/administration & dosage , Disinfection , Peritonitis/etiologyABSTRACT
As trissegmentectomias hepaticas sao operaçoes de grande porte e so recentemente tem sido empregadas no tratamento de tumores do figado. Consistem na remoçao de todo um lobo de figado mais o segmento medial do lobo remanescente. Se por um lado e bem definida a delimitaçao dos segmentos medial e lateral do lobo esquerdo, pelo outro existe dificuldade na definiçao anterior e posterior do lobo direito, o que limita a realizaçÀo da trissegmentectomia E. Estas intervençoes foram praticadas em seis doentes, sendo cinco portadores de tumor maligno e um com hemangiomas volumoso. A trissegmentectomia direita foi praticada em dois doentes e a esquerda em quatro, sendo que em dois destes infiltrava a parede gastrica, obrigando a ressecçao gastrica parcial em um e total no outro. O tempo operatorio variou de 6 a 9 1/2 horas e a reposiçao de sangue de 500ml a 12 litros. Ocorreram complicaçoes pos-operatorias em tres doentes: fistula biliar de baixo debito, derrame pleural hemorragico e ascite de dificil tratamento. Ocorreu um obito no 8§ dia de pos-operatorio por choque septico
Subject(s)
Adult , Humans , Male , Female , Hepatectomy , Liver NeoplasmsABSTRACT
A presença de nutrientes na luz intestinal e essencial para a adaptaçao estrutural e funcional do segmento intestinal remanescente apos enterectomia extensa. O proposito deste estudo foi o de avaliar a influencia de dietas com fontes nitrogenadas diferentes na adaptaçao intestinal apos ressecçao de 80% de jejuno-ileo. Administramos dietas `a base de aminoacidos (A), hidrolisado de proteinas (H), caseina (C) e dieta-padrao (P), em um modelo experimental padronizado. O grupo enterectomizado (E) foi comparado com um grupo controle (C), cada qual composto por 20 animais. Dividimos os grupos C e E em 4 subgrupos,A, H, C e P (n = 5), aos quais administramos as respectivas dietas. Avaliamos a evoluçao ponderal, niveis sericos de proteinas totais e albumina e alteraçoes histologicas e parametros morfometricos - fraçao de volume, profundidade da cripta, altura da vilosidade, indice metafasico e taxa de produçao celular horaria nascelulas da mucosa intestinal, apos periodo adaptativo de 30 dias. Os resultados mostraram ganho ponderal mais acentuado e melhor resposta adaptativa intestinal, estatisticamente significante (p < 0,005), nos animais enterectomizados aos quais administrou-se a dieta-padrao. Concluimos ter esta um melhor efeito na resposta adaptativa intestinal, apos enterectomia extensa
Subject(s)
Rats , Animals , Diet Therapy , Short Bowel Syndrome/surgery , Short Bowel Syndrome/diet therapyABSTRACT
A coledocoduodenostomia lĂĄtero-lateral Ă© uma tĂ©cnica de derivaçÀo bileo-digestiva muito empregada nas obstruçöes benignas e malignas da via biliar. A ocorrĂȘncia de fĂstulas ou estenose da anastomose, o refluxo do conteĂșdo duodenal para a ĂĄrvore biliar e o acĂșmulo de cĂĄlculos e resĂduos alimentares no coto coledociano distal - Sump Syndrome como causas de colangite pĂłs-operatĂłria, sĂ€o as principais crĂticas a sua utilizaçÀo. Os autores apresentam uma modificaçÀo tĂ©cnica, empregada em 11 doentes portadores de coledocolitĂase, capaz de ocluir o coto coledociano com o objetivo de prevenir a ocorrĂȘncia da "SĂndrome do colĂ©doco distal"
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Choledochostomy , Common Bile Duct Diseases/surgeryABSTRACT
Com o objetivo de verificar a eficĂĄcia da Ultra-sonografia Transparietal na avaliçÀo diagnĂłstica prĂ©-operatĂłria da via biliar principal, analisamos retrospectivamente 91 casos de coledocolitiĂĄse operados, e que foram submetidos a esta intervençÀo. A imagem ecogĂȘnica sugestiva de cĂĄlculo coledociano foi verificada em 31 doentes (34%) e em 70 (77%) foi feito o diagnĂłstico de dilataçÀo da via biliar. A acurĂĄcia foi de 84% para a dilataçÀo do colĂ©doco e de 34% para presença de cĂĄlculos, e a sensibilidade de 82% e 34%, respectivamente. Os resultados mostraram que o mĂ©todo Ă© satisfatĂłrio para o diagnĂłstico de dilataçÀo do colĂ©doco mas, no entanto, pouco sensĂvel na identificaçÀo de cĂĄlculos nessa via