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1.
Acta Chir Belg ; 119(6): 406-410, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31204903

RESUMO

Introduction: Many different approaches for the repair of a perineal hernia (PH) after abdomino-perineal rectum amputation (APR) have been described throughout the years. Literature shows us that the use of a mesh had the best results with relatively low rates of recurrence compared to primary suture. Yet there is still no consensus on the best technique for fixation of the mesh in the perineal cavity. Methods: We want to introduce an addition to the surgical repair technique, using laparoscopic glue to ensure a solid fixation of the mesh. This is to prevent small bowel from sliding into the perineal area due to the high abdominal pressure when standing and to avoid the difficulties and risks of laparoscopical suturing in this area. Results: This use of glue for fixation of the mesh has been successful in the three cases described, with no recurrence after one-year follow-up. Conclusion: A recurrent PH can be prevented by a solid fixation of the mesh using the technique of a glued mesh repair. This technique shows to be easy, fast and without recurrence.


Assuntos
Adenocarcinoma/terapia , Hérnia/etiologia , Herniorrafia/métodos , Períneo/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/terapia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telas Cirúrgicas , Técnicas de Sutura , Adesivos Teciduais/uso terapêutico
2.
Am J Transplant ; 17(7): 1802-1812, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28117941

RESUMO

Heart transplantation is the therapy of choice for end-stage heart failure. However, hemodynamic instability, which has been demonstrated in brain-dead donors (BDD), could also affect the posttransplant graft function. We tested the hypothesis that treatment of the BDD with the dopamine derivate n-octanoyl-dopamine (NOD) improves donor cardiac and graft function after transplantation. Donor rats were given a continuous intravenous infusion of either NOD (0.882 mg/kg/h, BDD+NOD, n = 6) or a physiological saline vehicle (BDD, n = 9) for 5 h after the induction of brain death by inflation of a subdural balloon catheter. Controls were sham-operated (n = 9). In BDD, decreased left-ventricular contractility (ejection fraction; maximum rate of rise of left-ventricular pressure; preload recruitable stroke work), relaxation (maximum rate of fall of left-ventricular pressure; Tau), and increased end-diastolic stiffness were significantly improved after the NOD treatment. Following the transplantation, the NOD-treatment of BDD improved impaired systolic function and ventricular relaxation. Additionally, after transplantation increased interleukin-6, tumor necrosis factor TNF-α, NF-kappaB-p65, and nuclear factor (NF)-kappaB-p105 gene expression, and increased caspase-3, TNF-α and NF-kappaB protein expression could be significantly downregulated by the NOD treatment compared to BDD. BDD postconditioning with NOD through downregulation of the pro-apoptotic factor caspase-3, pro-inflammatory cytokines, and NF-kappaB may protect the heart against the myocardial injuries associated with brain death and ischemia/reperfusion.


Assuntos
Morte Encefálica , Dopamina/análogos & derivados , Transplante de Coração/métodos , Precondicionamento Isquêmico , Traumatismo por Reperfusão/prevenção & controle , Doadores de Tecidos , Função Ventricular Esquerda/fisiologia , Animais , Caspase 3/metabolismo , Dopamina/farmacologia , Interleucina-6/metabolismo , Masculino , NF-kappa B/metabolismo , Ratos , Ratos Endogâmicos Lew , Fator de Necrose Tumoral alfa/metabolismo , Função Ventricular Esquerda/efeitos dos fármacos
4.
Acta Chir Belg ; 115(4): 273-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26324028

RESUMO

BACKGROUND: Worldwide, proton pump inhibitors (PPIs) are frequently used to prevent marginal ulcers after Roux-en-Y gastric bypass (RYGB) surgery. The aim of this retrospective study was to assess the prophylactic value of PPIs after a RYGB. METHODS: We retrospectively collected data on 200 patients with morbid obesity, who underwent RYGB surgery between August 2012 and August 2013. The patients were further divided into two groups according to whether or not they had been given prophylactic PPIs after the RYGB. Marginal ulcers were diagnosed based on reported symptoms and confirmed by endoscopy. RESULTS: The average follow-up time was 6.7 months. Postoperative gastroscopy was performed in 23 patients. A marginal ulcer was diagnosed in 13 patients. Only four of these patients were taking prophylactic PPIs, of which three patients had already started taking them prior to surgery. Although marginal ulcers occurred less frequently in patients undergoing prophylactic treatment with PPIs (p-value 0.200), we were unable to demonstrate any statistically significant reduction in the number of ulcers. In addition, major risk factors such as nicotine abuse, NSAIDS and H. pylori did not appear to influence the incidence. CONCLUSIONS: Although our results suggest that PPIs reduce the incidence of marginal ulcers, we were unable to confirm this statistically. Our study was limited by the small study population and short follow-up period. In light of the lack of available scientific evidence and the growing problem of obesity, we believe that robust, large-scale prospective studies are necessary.


Assuntos
Derivação Gástrica , Complicações Pós-Operatórias/prevenção & controle , Inibidores da Bomba de Prótons/uso terapêutico , Úlcera Gástrica/prevenção & controle , Adulto , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Úlcera Gástrica/etiologia
5.
Acta Chir Orthop Traumatol Cech ; 82(3): 192-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26317289

RESUMO

PURPOSE OF THE STUDY This study aimed to analyse the outcome following intramedullary nailing for metastases of the femur in a large cohort with special regard to mechanical, implant associated complications and patient survival. Furthermore, we aimed to identify factors influencing the overall survival. MATERIAL AND METHODS All patients (n = 74) that underwent intramedullary nailing for metastatic disease of the femur between 2004 and 2008 and were retrospectively reviewed. Data were recorded from the patients' medical record and the outpatients' clinics files. Details about the tumour biology, the surgery performed as well as the postoperative care were documented. Survival data were extracted from patient records or obtained via communication with outpatient oncologists or the community registration office. RESULTS 74 (28 (37.8%) male, 46 (62.2%) female; p = 0.048) patients with a mean age of 64.4 ± 11.7 years were included. Breast (25, 33.8%), lung (18, 24.3%), bone marrow (7, 9.5%) and kidney (6, 8.1%) were the primary tumours in more than 75% of all patients. The mean overall survival was 17.5 (95% CI: 9.6 - 25.5) months. Patients with osseous metastases had a significant longer survival than patients with visceral and/or cerebral metastases (p = 0.025 and p = 0.032). CONCLUSION Intramedullary nailing represents a valuable fixation method for pathologic fractures or impending fractures of the femur in patients with an advanced stage of metastatic disease. It provides adequate stability to outlast the patient s remaining life-span. However, the balance must be found between therapeutic resignation and surgical overtreatment since operative treatment may be accompanied with serious complications. Key words: bone metastases, intramedullary nailing, metastatic disease, cement augmentation, osteolytic defect.


Assuntos
Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Fraturas Espontâneas/cirurgia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/secundário , Feminino , Fraturas do Fêmur/etiologia , Seguimentos , Fraturas Espontâneas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estudos Retrospectivos
6.
Acta Chir Orthop Traumatol Cech ; 81(6): 365-70, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25651290

RESUMO

PURPOSE OF THE STUDY Evaluation of outcome after surgical treatment of humerus metastases with a focus on tumour and patient derived factors, timing and strategy of intervention, surgical outcome and complications. MATERIAL AND METHODS Sixty-fie patients with a mean age of 64.3 years (range 25-89) with 66 metastases of the humerus were surgically treated in a 7-year time-period and retrospectively reviewed. RESULTS Renal cell carcinoma and breast cancer were the most abundant types of primary tumour. The mean time from diagnosis of primary tumour to fist metastasis was 14.5 months (range 0-173). The mean time from diagnosis of metastasis to surgery was 21.4 months (range 0-173). 38/28 intramedullary nails/locking plates were used for 58/8 manifest/impending pathological fractures. Mean cumulative survival was 16.3 months and implant failure rate was 6.1% with a mean time from initial surgery to revision of 22.2-20.6 months. CONCLUSIONS Our data indicate that treatment with intramedullary fiation or cement augmented plate osteosynthesis is successful for the vast majority of patients, but thorough clinical evaluation and precise decision making adapted to the patient's estimated life expectancy must be applied to avoid overtreatment or risk of implant failure. Key words: bone metastases, skeletal metastatic disease, humerus metastasis, pathologic fracture, impending fracture.


Assuntos
Cimentos Ósseos , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas Espontâneas/cirurgia , Fraturas do Úmero/cirurgia , Úmero/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Placas Ósseas , Feminino , Consolidação da Fratura , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/patologia , Humanos , Fraturas do Úmero/etiologia , Fraturas do Úmero/patologia , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
7.
Z Rheumatol ; 72(3): 270-8, 2013 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-23223892

RESUMO

After rheumatologic conservative medical therapy has been exhausted in degenerative and inflammatory joint diseases, arthroplastic operations are an important option to restore quality of life. Endoprosthesis-associated arthrofibrosis is a severe fibrosing disease of the synovial membrane after endoprosthetic operations. Neither the morphological substrate nor histopathological criteria have been described. The aim was to describe the histopathological substrate of arthrofibrosis and to define histological and immunohistochemical criteria of arthrofibrosis on the basis of tissue samples derived from revision. In histopathological analyses arthrofibrosis revealed a synovialitis with varying fibrosis, without detectable ossification and without minimal wear particle reaction (so-called synovialitis of arthrofibrotic type, SAT). A 3-stage grading was determined based on the cellular density of the fibrous tissue (fibroblast cellularity). In 191 cases with SAT, grade 1 was found in 24.1 % (n = 46), grade 2 was found in 51.8 % (n = 99) and grade 3 was found in 24.1 % (n = 46). The control group consisted of 29 cases with synovialitis of indifferent type (type IV membrane). If SAT grades 2 and 3 are summed together, i.e. the distance between the fibroblasts was less than two cell lengths, the difference of the fibroblast cellularity compared with the type IV membrane was significant (p < 0.001). Above SAT grade 2 the diagnosis of arthrofibrosis could be made with a sensitivity 0.7592 and specificity 0.8276. The SM-alpha-actin cytoplasmic positivity of fibroblasts indicates a myofibroblast phenotype and the ß-catenin positivity suggests a resemblance to fibromatosis or a keloid-like process. In the quantitative evaluation of the ß-catenin positive fibroblasts, there was a significant difference (p < 0.001) between type IV membrane and SAT. A threshold value of 20 beta-catenin positive cells per microscopic high power field (HPF) was determined, which represents in conjunction with the clinical information a new histopathological diagnosis component (sensitivity 0.720, specificity 0.867).


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/cirurgia , Prótese Articular/efeitos adversos , Sinovite/etiologia , Sinovite/patologia , Terminologia como Assunto , Idoso , Diagnóstico Diferencial , Feminino , Fibrose/etiologia , Fibrose/patologia , Humanos , Masculino , Pessoa de Meia-Idade
8.
Acta Chir Belg ; 113(6): 452-4, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24494475

RESUMO

Ectopic pancreatic tissue at the umbilicus is very rare. To our best knowledge, only fourteen cases of ectopic pancreatic tissue at the umbilicus are reported. In this paper we present the case of a two-year-old boy with an abrasion at the umbilicus. He had a poorly healing scar that started bleeding after recurrent injuries. Abdominal ultrasound revealed an unclear cystic structure with no communication to intra-abdominal structures. Surgical resection was performed without complications. Histology diagnosed an ectopic pancreatic tissue with reactive epidermal changes. We present a review of the literature and the clinical manifestations and treatment of the previously reported fourteen cases.


Assuntos
Coristoma/patologia , Pâncreas , Umbigo , Pré-Escolar , Coristoma/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Umbigo/patologia , Umbigo/cirurgia
9.
J Exp Med ; 182(2): 345-55, 1995 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-7629498

RESUMO

The heterodimeric alpha 4 integrins alpha 4 beta 7 lymphocyte Peyer's patch adhesion molecule ([LPAM]-1) and alpha 4 beta 1 (very late antigen-4) are cell surface adhesion molecules involved in lymphocyte trafficking and lymphocyte-cell and matrix interactions. Known cellular ligands include vascular cell adhesion molecule (VCAM)-1, which binds to alpha 4 beta 1 and alpha 4 beta 7, and the mucosal addressin cell adhesion molecule (MAdCAM)-1, which binds to alpha 4 beta 7. Here we show that the alpha 4 chain of these integrins can itself serve as a ligand. The alpha 4 chain, immunoaffinity purified and immobilized on glass slides, binds thymocytes and T lymphocytes. Binding exhibits divalent cation requirements and temperature sensitivity which are characteristic of integrin-mediated interactions, and is specifically inhibited by anti-alpha 4 integrin antibodies, which exert their effect at the cell surface. Cells expressing exclusively alpha 4 beta 7 (TK-1) or alpha 4 beta 1 (L1-2) both bound avidly, whereas alpha 4-negative cells did not. A soluble 34-kD alpha 4 chain fragment retained binding activity, and it inhibited lymphocyte adhesion to alpha 4 ligands. It has been shown that alpha 4 integrin binding to fibronectin involves an leucine-aspartic acid-valine (LDV) motif in the HepII/IIICS region of fibronectin (CS-1 peptide), and homologous sequences are important in binding to VCAM-1 and MAdCAM-1. Three conserved LDV motifs occur in the extracellular sequence of alpha 4. A synthetic LDV-containing alpha 4-derived oligopeptide supports alpha 4-integrin-dependent lymphocyte adhesion and blocks binding to the 34-kD alpha 4 chain fragment. Our results suggest that alpha 4 beta 7 and alpha 4 beta 1 integrins may be able to bind to the alpha 4 subunit on adjacent cells, providing a novel mechanism for alpha 4 integrin-mediated and activation-regulated lymphocyte interactions during immune responses.


Assuntos
Moléculas de Adesão Celular , Integrinas/metabolismo , Linfócitos/metabolismo , Receptores de Antígeno muito Tardio/metabolismo , Sequência de Aminoácidos , Animais , Anticorpos Monoclonais/imunologia , Adesão Celular , Ligantes , Linfócitos/citologia , Camundongos , Dados de Sequência Molecular , Oligopeptídeos/metabolismo , Ligação Proteica , Alinhamento de Sequência , Homologia de Sequência de Aminoácidos
10.
BJS Open ; 4(1): 145-156, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32011817

RESUMO

BACKGROUND: Reliable estimates for risk of cardiovascular-specific mortality and progression to end-stage renal disease (ESRD) among elderly patients undergoing major surgery are not available. This study aimed to develop simple risk scores to predict these events. METHODS: In a single-centre cohort of elderly patients undergoing major surgery requiring hospital stay longer than 24 h, progression to ESRD and long-term cardiovascular-specific mortality were modelled using multivariable subdistribution hazard models, adjusting for co-morbidity, frailty and type of surgery. RESULTS: Before surgery, 2·9 and 11·9 per cent of 16 655 patients had ESRD and chronic kidney disease (CKD) respectively. During the hospital stay, 46·9 per cent of patients developed acute kidney injury (AKI). Patients with kidney disease had a significantly higher risk of cardiovascular-specific (CV) mortality compared with patients without kidney disease (adjusted hazard ratio (HR) for CKD without AKI 1·60, 95 per cent c.i. 1·25 to 2·01; AKI without CKD 1·70, 1·52 to 1·87; AKI with CKD 2·80, 2·50 to 3·20; ESRD 5·21, 4·32 to 6·27), as well as increased progression to ESRD (AKI without CKD 5·40, 3·44 to 8·35; CKD without AKI 8·80, 4·60 to 17·00; AKI with CKD 31·60, 19·90 to 49·90). CV Death and ESRD Risk scores were developed to predict CV mortality and progression to ESRD. Calculated CV Death and ESRD Risk scores performed well with c-statistics: 0·77 (95 per cent c.i. 0·76 to 0·78) and 0·82 (0·78 to 0·86) respectively at 1 year. CONCLUSION: Kidney disease in elderly patients undergoing major surgery is associated with a high risk of CV mortality and progression to ESRD. Risk scores can augment the shared decision-making process of informed consent and identify patients requiring postoperative renal-protective strategies.


ANTECEDENTES: No se dispone de estimaciones fiables acerca del riesgo de mortalidad cardiovascular y de progresión a insuficiencia renal terminal (end-stage renal disease, ESRD) en pacientes longevos a los que se realiza cirugía mayor. Este estudio tiene como objetivo desarrollar un sistema de puntuación simple de riesgos para predecir estos eventos. MÉTODOS: En una cohorte de un solo centro de 16.655 pacientes longevos a los que se realizó cirugía mayor con hospitalización de más de 24 horas, se estimó la progresión a ESRD y la mortalidad cardiovascular a largo plazo utilizando modelos multivariables de subdistribucion de riesgos ajustados por comorbilidades, fragilidad y tipo de cirugía. RESULTADOS: Antes de la cirugía, presentaron ESRD y enfermedad renal crónica (chronic kidney Disease, CKD) un 2,9% y un 12,3% de los pacientes, respectivamente. Durante la hospitalización, el 46,9% de los pacientes desarrollaron insuficiencia renal aguda (acute kidney injury, AKI). Los pacientes con enfermedad renal tenían un riesgo significativamente mayor de mortalidad cardiovascular (CV) en comparación con los pacientes sin enfermedad renal para presentar AKI (cociente de riesgos instantáneos, hazard ratio, HR ajustado) 1,6 (i.c. del 95% 1,3-2,0), AKI sin CKD 1,7 (1,5-1,9), AKI en presencia de CKD 2,8 (2,5-3,2) y ESRD 5,2 (4,3-6,3), así como una mayor progresión a ESRD (AKI sin CKD 5,4 (3,4-8,4), CKD sin AKI 8,8 (4,6-17), y AKI en presencia de CKD 31,6 (19,9-49,9)). Se desarrollaron las escalas CV Death y ESRD Risk para predecir la mortalidad cardiovascular y la progresión a ESRD. Ambas escalas funcionaron bien a 1 año con un coeficiente de concordancia de 0,77 (i.c. del 95% 0,76-0,78) y 0,82 (0,78-0,86) respectivamente. CONCLUSIÓN: La enfermedad renal en pacientes longevos tras cirugía mayor se asocia con un elevado riesgo de mortalidad cardiovascular y de progresión a ESRD. Las escalas de riesgo pueden facilitar la toma de decisiones en el momento del consentimiento informado e identificar los pacientes que requieren estrategias de protección renal postoperatorias.


Assuntos
Injúria Renal Aguda/complicações , Doenças Cardiovasculares/mortalidade , Falência Renal Crônica/complicações , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Progressão da Doença , Feminino , Florida/epidemiologia , Hospitalização , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Complicações Pós-Operatórias/mortalidade , Modelos de Riscos Proporcionais , Fatores de Risco
11.
J Cell Biol ; 131(6 Pt 2): 1881-91, 1995 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8557754

RESUMO

The L1 adhesion molecule is a member of the immunoglobulin superfamily shared by neural and immune cells. In the nervous system L1 can mediate cell binding by a homophilic mechanism. To analyze its function on leukocytes we studied whether L1 could interact with integrins. Here we demonstrate that VLA-5, an RGD-specific fibronectin receptor on a wide variety of cell types, can bind to murine L1. Mouse ESb-MP cells expressing VLA-5 and L1 could be induced to aggregate in the presence of specific mAbs to CD24 (heat-stable antigen), a highly and heterogeneously glycosylated glycophosphatidylinositol-linked differentiation antigen of hematopoietic and neural cells. The aggregation was blocked by both mAbs to L1 and VLA-5, respectively. Aggregation was blocked also by a synthetic RGD-containing peptide derived from the Ig-domain VI of the L1 protein. ESb-MP subclones with low L1 expression could not aggregate. In heterotypic binding assays mouse bone marrow cells could adhere in an L1-dependent fashion to platelets that expressed VLA-5. Also purified L1 coated to polystyrene beads could bind to platelets. The binding of L1-beads was again inhibited by mAbs to L1 and VLA-5, by soluble L1 and the L1-RGD peptide in a dose-dependent manner. Thymocytes or human Nalm-6 tumor cells expressing VLA-5 could adhere to affinity-purified L1 and to the L1-derived RGD-containing peptide coated to glass slides. The adhesion was strongly enhanced in the presence of Mn(2+)-ions and blocked by mAbs to VLA-5. We also demonstrate a direct L1-VLA-5 protein interaction. Our results suggest a novel binding pathway, in which the VLA-5 integrin binds to L1 on adjacent cells. Given its rapid downregulation on lymphocytes after induction of cell proliferation, L1 may be important in integrin-mediated and activation-regulated cell-cell interactions.


Assuntos
Antifúngicos/metabolismo , Moléculas de Adesão de Célula Nervosa/metabolismo , Receptores de Fibronectina/metabolismo , Sequência de Aminoácidos , Animais , Anticorpos Monoclonais , Plaquetas/citologia , Células da Medula Óssea , Adesão Celular/fisiologia , Agregação Celular/fisiologia , Endotélio Vascular/citologia , Humanos , Complexo Antígeno L1 Leucocitário , Camundongos , Dados de Sequência Molecular , Monócitos/citologia , Moléculas de Adesão de Célula Nervosa/isolamento & purificação , Oligopeptídeos/isolamento & purificação , Oligopeptídeos/metabolismo , Receptores de Fibronectina/imunologia , Timo/citologia , Células Tumorais Cultivadas/metabolismo
12.
J Child Orthop ; 13(4): 346-352, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31489039

RESUMO

PURPOSE: Therapy of juvenile neurogenic flatfoot (JNF) with subtalar arthroereisis (SA) is currently under critical clinical investigation. In this retrospective matched pair analysis, the radiological outcome after arthroereisis in paediatric patients with infantile cerebral palsy and JNF was compared with children with juvenile flatfeet (JF) without neurological diseases. METHODS: From October 2007 to April 2018 80 patients with 149 flatfeet underwent surgery with SA. Inclusion criteria were: 1) JNF or JF with age at surgery ≤ 13 years; 2) treatment with SA; 3) presence of three sets of biplane radiographs (preoperative, postoperative and follow-up (FU)). The radiographs were analyzed for: 1) navicular-cuboidal-index (NCI); 2) talocalcaneal angle anteroposterior; 3) talocalcaneal angle lateral; 4) calcaneal-pitch (CP); and 5) talometatarsal-index (TMTI). Following this, 25 patients with 38 flatfeet could be included. RESULTS: The mean age at SA of the JNF group was 9.2 years (JF group: 9.3 years) and the mean time of FU was 35.2 months (JF group: 39.4 months). In comparison with preoperatively, a significant decrease of the NCI was seen in both groups (p = ≤ 0.05 and p = ≤ 0.001) in the FU radiographs. The analysis of CP and TMTI in the JF group also resulted in a significant improvement (p = ≤ 0.001 and p = ≤ 0.05). Overall, the comparison between the JNF and JF group showed no significant differences in regard to the analyzed postoperative parameters. CONCLUSION: Based on this data, treatment of flatfeet by SA in patient with neurological disorders shows an improvement of radiological parameters comparable with neurologically unimpaired patients and might be considered as additional treatment option. LEVEL OF EVIDENCE: IV.

13.
Surg Endosc ; 22(7): 1690-6, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18071805

RESUMO

BACKGROUND: The Roux-en-Y gastric bypass procedure (RYGBP) is in many countries the gold standard for obtaining long-lasting weight reduction and improvement of obesity-related comorbidities. However, performing this operation by standard laparoscopic techniques requires important surgical skills because of the anastomoses involved. The da Vinci surgical robot system with its enhanced degrees of freedom in motion and three-dimensional vision is designed to overcome the difficulties encountered in traditional laparoscopic surgery with suturing and delicate tissue handling. METHODS: For this study, 45 patients (9 men) with a mean body mass index (BMI) of 44.2 (range, 35.1-55.4) underwent RYGBP with the aid of the da Vinci robot system. They were compared with 45 consecutive patients with a mean BMI of 43.9 (range, 35.1-56.2) who underwent a laparoscopic RYGBP by the same surgeon during the same period. RESULTS: Overall, the total operating time was shorter for the laparoscopic cases (127 vs 212 min; p < 0.05). However, the last 10 robotic cases were performed in the same time span as the laparoscopic cases (136 vs 127 min). The total robotic setup time remained constant at about 30 min. There were no differences in postoperative complications between the two groups in terms of anastomotic leakage or stenosis. In the robotic group, more conversions to open surgery were noted. Early in the study, four patients (9%) had to undergo conversion to standard laparoscopic techniques due to inadequate setup of the robotic arms. Five patients (11%), however, had to undergo conversion to open surgery because of intestinal laceration during manipulation of the intestines with the robotic instruments. The costs were higher for robotic surgery than for standard laparoscopic RYGBP, mainly because of the extra equipment used, such as ultrasonic devices. CONCLUSION: The RYGBP procedure can be performed safely with the da Vinci robot after a learning curve of about 35 cases. At this writing, however, it is not clear whether the da Vinci system offers a real advantage over standard laparoscopic techniques.


Assuntos
Derivação Gástrica/economia , Derivação Gástrica/métodos , Laparoscopia/economia , Obesidade Mórbida/cirurgia , Robótica/economia , Adulto , Custos e Análise de Custo , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade
14.
Acta Chir Belg ; 107(4): 468-71, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17966553

RESUMO

A case of a liposarcoma of the stomach in a 27-year old woman is described. Initially the patient consulted with epigastric pain. MRI showed a giant tumour of the stomach wall, invading the surrounding organs, as well as the mediastinal region. After surgical 'en-bloc' resection of the tumour, histopathologic examination yielded a diagnosis of pleiomorphic liposarcoma. Because of the bad prognosis of this histologic type, the patient received adjuvant chemotherapy: a combination of doxorubicin and ifosfamide (MAI). Nine months after surgery, she represented with a relapse of the tumour that had become inoperable. Palliative chemotherapy was started with the intent to prolong the young patient's life. However 6 months later, the patient died of the recurrent disease. Although liposarcoma is a very common soft tissue sarcoma, it is rarely seen in the stomach. The standard therapy is surgical excision. Over the last years, adjuvant therapy became more accepted. Drugs of choice are doxorubicin and ifosfamide, although the benefits of this therapy are still largely unknown and doubtful.


Assuntos
Lipossarcoma/patologia , Mediastino/patologia , Neoplasias Gástricas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Feminino , Humanos , Lipossarcoma/tratamento farmacológico , Masculino , Mediastino/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Gástricas/tratamento farmacológico
15.
Acta Chir Belg ; 106(2): 225-7, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16761484

RESUMO

Vasculitis leading to intestinal necrosis is a rare complication of rheumatoid arthritis. The introduction of anti-TNF treatment for methotrexate-resistant cases improved disease-control substantially in these often more aggresive forms of rheumatoid arthritis. As far as we know only two cases of severe vasculitis following anti-TNF treatment have been reported. We describe a 45-year old female patient with severe rheumatoid arthritis, who presented with an epileptic insult, renal failure and a quickly deteriorating general condition due to intestinal vasculitis, while she had been receiving anti-TNF treatment for 6 months.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Intestinos/irrigação sanguínea , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Vasculite/etiologia , Artrite Reumatoide/complicações , Feminino , Humanos , Infliximab , Pessoa de Meia-Idade , Necrose , Vasculite/patologia
17.
Acta Chir Belg ; 105(2): 161-7, 2005 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-15906907

RESUMO

OBJECTIVE: To compare gastric banding (GB) and vertical banded gastroplasty (VBG) with respect to the evolution of pyrosis and patient satisfaction. SUMMARY BACKGROUND DATA: Although weight loss is the most immediate end-point in the evaluation of surgical treatment of obesity, the demonstration of changes in long-term patient satisfaction and in co-morbidity, like reflux, is an essential outcome measure. MATERIAL AND METHODS: Retrospective study of 243 morbidly obese patients. All patients received a questionnaire regarding the evolution of pyrosis and their satisfaction after surgery. The evolution of pyrosis was compared between 2 patient groups who had different oesophagitis stages. Group A had oesophagitis I, or no oesophagitis, and group B had oesophagitis II, III or IV. RESULTS: In group A of the GB group 57.8% had no complaints, 11.1% had improvement and 22.2% had aggravation of the pyrosis. In group B of the GB group 50.0% had improvement. In group A of the VBG group 51.4% had no complaints, 11.1% improvement and 23.6% aggravation of the pyrosis. In group B of the VBG group 16.7% had no complaints, 66.6% had improvement and 16.7% had aggravation of the pyrosis complaints. Statistically there is no significant difference between GB and VBG. The experience after GB is good with 67.9%, mediocre with 25.0% and bad with 7.1% of the patients ; 60.7% is pleased with the weight loss. The experience after VBG is good with 47.4%, mediocre with 29.5% and bad with 23.1% of the patients. 52.6% is satisfied with the weight loss. CONCLUSION: VBG and GB have a similar effect on pyrosis. From our point of view it has been evidenced that the presence or absence of pyrosis before the operation is a possible predictor of the evolution afterwards. Long-term patient satisfaction is the same after GB and VBG. Other factors influence the satisfaction.


Assuntos
Refluxo Gastroesofágico/epidemiologia , Gastroplastia/efeitos adversos , Gastroplastia/instrumentação , Azia/epidemiologia , Obesidade Mórbida/cirurgia , Adulto , Distribuição por Idade , Intervalos de Confiança , Feminino , Seguimentos , Balão Gástrico/efeitos adversos , Refluxo Gastroesofágico/etiologia , Gastroplastia/métodos , Azia/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Razão de Chances , Satisfação do Paciente , Complicações Pós-Operatórias/epidemiologia , Probabilidade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Resultado do Tratamento , Redução de Peso
18.
Hypertension ; 22(3): 331-8, 1993 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8349326

RESUMO

Blood pressure responses to 1 week of low-salt (20 mmol sodium/d) and high-salt (300 mmol sodium/d) intake were investigated in a single-blind randomized study in 163 white, nonobese normotensive subjects (65 women and 98 men; mean age, 38 +/- 1.2 years). The individuals were classified as salt sensitive when mean arterial blood pressure rose by at least 5 mm Hg during high-salt intake, as salt resistant when mean arterial blood pressure changed by less than 5 mm Hg, and as "counterregulator" when mean arterial blood pressure fell by at least 5 mm Hg during the high-salt diet. Reexamination of 31 subjects showed that this approach to the testing of salt sensitivity was reliable and reproducible. Thirty subjects (18.4%) were classified as salt sensitive, 108 (66.3%) as salt resistant, and 25 (15.3%) as counterregulators. Multiple regression analysis revealed that age, body weight, and family history of hypertension contributed significantly to the change in blood pressure after the diets. Salt sensitivity was more frequent in older subjects and in those with a positive family history of hypertension. An increase in blood pressure after salt restriction was more likely in younger individuals and in those with a negative family history of hypertension. Plasma renin activity and plasma aldosterone concentrations were lower in salt-sensitive compared with salt-resistant and counterregulating subjects. The rise in plasma renin activity during salt restriction was most pronounced in counterregulating subjects. Plasma norepinephrine concentrations were not different among the groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Fator Natriurético Atrial/sangue , Pressão Sanguínea/efeitos dos fármacos , Renina/sangue , Cloreto de Sódio/administração & dosagem , Sódio na Dieta/administração & dosagem , Adulto , Fatores Etários , Aldosterona/sangue , Peso Corporal , Saúde da Família , Feminino , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Reprodutibilidade dos Testes , Método Simples-Cego
19.
J Hypertens ; 11(7): 743-9, 1993 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8228194

RESUMO

OBJECTIVE: The effects of severe and moderate sodium restriction on blood pressure, neurohormonal activity and serum lipids were studied in non-obese normotensive adults. METHODS: In the first part of the study, 163 subjects were randomly assigned to a diet of 20 or 300 mmol/day sodium for 1 week each. In the second part, 25 subjects were given a diet of 85 or 200 mmol/day sodium for 4 weeks each in random order. RESULTS: After severe salt restriction 19% of the subjects had a significant decline (salt-sensitive group), 15% showed a significant rise (counter-regulator group) and 66% exhibited no change in blood pressure (salt-resistant group). Severe sodium restriction increased plasma renin activity and noradrenaline concentration, as well as serum total and low-density lipoprotein-cholesterol and triglycerides. After correction for haematocrit, only the changes in total and low-density lipoprotein-cholesterol remained significant. The rise in plasma renin activity during salt restriction was steeper in the counter-regulator group than in the other groups, whereas the changes in plasma noradrenaline concentrations were similar in all groups. During moderate salt restriction, plasma renin activity and noradrenaline concentration were significantly increased, but serum lipid concentrations and blood pressure did not change. CONCLUSION: In non-obese normotensive adults, severe and moderate salt restriction stimulates neurohormonal activity. In contrast to severe salt restriction, a moderate reduction in dietary salt intake does not influence blood lipids in normotensive subjects.


Assuntos
Pressão Sanguínea , Dieta Hipossódica , Lipídeos/sangue , Norepinefrina/sangue , Renina/sangue , Adulto , Feminino , Humanos , Masculino , Concentração Osmolar , Valores de Referência
20.
Am J Hypertens ; 8(8): 829-36, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7576400

RESUMO

Blood pressure responses to 1 week of low (20 mmol sodium/day) and high (300 mmol sodium/day) salt intake were investigated in a double-blind, randomized study in 46 white, nonobese subjects with essential hypertension (13 women, 33 men; mean age 45.3 +/- 2.2 years, age range 25 to 80 years). The individuals were classified as salt-sensitive when mean arterial blood pressure rose by at least 5 mm Hg during high salt intake, as salt-resistant when mean arterial blood pressure changed by less than 5 mm Hg, and as "counter-regulators" when mean arterial blood pressure fell by at least 5 mm Hg during the high salt diet. Mean arterial blood pressure of all subjects taken together increased from 101.9 +/- 1.4 mm Hg during salt restriction to 103.7 +/- 1.5 mm Hg (P < .05) during salt loading. Eleven subjects (23.9%) were classified as salt-sensitive, 27 (58.7%) as salt-resistant, and 8 (17.4%) as counter-regulators. Multiple regression analysis revealed that age, but not baseline blood pressure, sex, body mass index, or family history of hypertension contributed significantly to the change in blood pressure following the diets. Ten of the 11 salt-sensitive subjects were older than the median age of 45 years. In salt-sensitive, as compared to salt-resistant, hypertensive subjects, creatinine clearance was lower and plasma renin activity was suppressed at baseline as well as during low and high salt intake. In contrast, plasma concentrations of norepinephrine and atrial natriuretic peptide were elevated in salt-sensitive subjects. These differences between the groups appeared, at least partially, to be age-related.(ABSTRACT TRUNCATED AT 250 WORDS)


Assuntos
Pressão Sanguínea/fisiologia , Dieta Hipossódica , Hipertensão/dietoterapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aldosterona/sangue , Fator Natriurético Atrial/sangue , Índice de Massa Corporal , Creatinina/metabolismo , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Norepinefrina/sangue , Análise de Regressão , Renina/sangue , Sódio/metabolismo
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