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1.
Medicine (Baltimore) ; 99(22): e19991, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481367

RESUMO

To analyze patient satisfaction and the predictive factors characterizing three types of one-stage immediate breast reconstruction (IBR) after mastectomy, including prosthesis, latissimus dorsi myocutaneous flap (LDMF), transverse rectus abdominis myocutaneous (TRAM) flap techniques.Data were collected via face-to-face or telephone interviews from eight breast centers in China from January 2012 to December 2016. A standardized questionnaire that evaluated the general satisfaction and aesthetic satisfaction was sent to patients who had undergone IBR. Logistic regression analysis was performed to identify risk factors associated with patient satisfaction among the three types of breast reconstruction.A total of 412 questionnaires were sent out, and 309 copies were collected including 226 prosthesis, 46 LDMF, and 37 pedicle TRAM reconstruction. Logistic regression analysis showed that general satisfaction and aesthetic satisfaction were significantly correlated with radiotherapy (P < .001, P = .018), respectively. Besides, the aesthetic satisfaction was also associated with nipple-areola complex (NAC) preservation (P < .001).Our multi-center study identified factors of higher patient satisfaction, like NAC preservation and absence of radiotherapy, in order to help breast surgeons make better decisions about individualized reconstruction plan.


Assuntos
Implantes de Mama/psicologia , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Mastectomia , Satisfação do Paciente/estatística & dados numéricos , Adulto , Implantes de Mama/estatística & dados numéricos , Feminino , Humanos , Mamoplastia/psicologia , Pessoa de Meia-Idade , Reto do Abdome/transplante , Músculos Superficiais do Dorso/transplante , Retalhos Cirúrgicos/estatística & dados numéricos
2.
PLoS One ; 15(4): e0231096, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243473

RESUMO

BACKGROUND AND OBJECTIVE: In the present study, we compared the effect of diabetic pregnancy on the rectus abdominis muscle (RAM) in humans and rats. We hypothesized that our animal model could provide valuable information about alterations in the RAM of women with Gestational Diabetes (GDM). METHOD: Newborns female rats (n = 10/group) were administered streptozotocin (100 mg/kg body weight) subcutaneously and were mated on reaching adulthood, to develop the mild hyperglycemic pregnant (MHP) rat model. At the end of pregnancy, the mothers were sacrificed, and the RAM tissue was collected. Pregnant women without GDM (non-GDM group; n = 10) and those diagnosed with GDM (GDM group; n = 8) and undergoing treatment were recruited, and RAM samples were obtained at C-section. The RAM architecture and the distribution of the fast and slow fibers and collagen were studied by immunohistochemistry. RESULTS: No statistically significant differences in the maternal and fetal characters were observed between the groups in both rats and women. However, significant changes in RAM architecture were observed. Diabetes in pregnancy increased the abundance of slow fibers and decreased fast fiber number and area in both rats and women. A decrease in collagen distribution was observed in GDM women; however, a similar change was not observed in the MHP rats. CONCLUSION: Our results indicated that pregnancy- associated diabetes- induced similar structural adaptations in the RAM of women and rats with slight alterations in fiber type number and area. These findings suggest that the MHP rat model can be used for studying the effects of pregnancy-associated diabetes on the fiber structure of RAM.


Assuntos
Diabetes Gestacional/patologia , Reto do Abdome/patologia , Adulto , Animais , Peso Corporal , Modelos Animais de Doenças , Feminino , Feto/anatomia & histologia , Teste de Tolerância a Glucose , Humanos , Masculino , Gravidez , Ratos Wistar
3.
Zhonghua Shao Shang Za Zhi ; 36(4): 297-303, 2020 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-32340420

RESUMO

Objective: To explore the effects of pedicled rectus abdominis myocutaneous (PRAM)flap combined with free deep inferior epigastric artery perforator (DIEAP) flap carrying inguinal lymphatic flap in breast reconstruction and upper limb lymphedema treatment post radical mastectomy. Methods: From October 2014 to September 2016, 9 patients with upper limb lymphedema after mastectomy were treated with PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap for breast reconstruction and upper limb lymphedema treatment in Hunan Province Cancer Hospital. The patients were all females, aged 34-66 (44±7) years. The location of deep inferior epigastric artery perforator was detected by audible Doppler ultrasound blood stream detector and computed tomography angiography for designing combined tissue flap, with length of (25.32±0.27) cm, width of (13.14±0.76) cm, and thickness of (3.55±0.34) cm. The donor site of combined tissue flap was closed by suturing, and two or more tubes for negative pressure drainage were placed according to the situation of donor site and recipient site. Operation time and average placing time of negative pressure drainage tube, postoperative condition of combined tissue flap and the donor site, reconstructed breast condition, recovery of upper limb lymphedema were documented and followed up. Results: The operation time was 290-420 (396±55) min. The average retaining time of negative pressure drainage tube in breast was 5.9 d, while the average retaining time of negative pressure drainage tube in abdomen was 4.3 d. Ecchymoma occurred in DIEAP flap of one patient and in the flap donor site of another patient. Delayed healing was also seen in the rectus abdominis myocutaneous flap of a patient, which healed eventually after dressing change, and the other flaps survived well. The appearance of reconstructed breast was good with good elasticity, and no contracture or deformation occurred in the tissue flap. The upper limb lymphedema in 7 patients was alleviated in varying degrees, with 2.0-4.0 cm reduction in circumference. During follow-up of 12-24 months of 9 patients, averaged 17.5 months, with 6 patients received long term bandage pressure therapy and physical therapy to the affected limbs after operation and all patients were satisfied with appearances of the affected limbs. Neuropathic pain in affected limbs was significantly relieved in 2 patients and stopped aggravating in the other 2 patients. Only linear scar was seen in the donor site of abdomen without affecting obviously the function of abdomen. Conclusions: The PRAM flap combined with free DIEAP flap carrying inguinal lymphatic flap is an effective way for breast reconstruction and upper limb lymphedema treatment post mastectomy.


Assuntos
Neoplasias da Mama , Linfedema , Mamoplastia , Retalho Miocutâneo , Retalho Perfurante , Adulto , Idoso , Neoplasias da Mama/cirurgia , Artérias Epigástricas , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Reto do Abdome , Extremidade Superior
4.
Plast Reconstr Surg ; 145(3): 491e-498e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097296

RESUMO

BACKGROUND: After breast reconstruction, nipple position and other long-term changes in the reconstructed breast relative to the contralateral breast remain poorly understood. In this prospective cohort study, the authors performed serial nipple position measurements over 5 years in patients who had undergone breast reconstruction with a transverse rectus abdominis musculocutaneous (TRAM) flap. The effects of adjuvant radiotherapy on nipple position over time were also investigated. METHODS: The authors studied 150 patients who had undergone nipple-sparing mastectomy, using radial incision followed by immediate unilateral pedicled TRAM flap breast reconstruction. Measurements of sternal notch-to-nipple, midline-to-nipple, and inframammary fold-to-nipple distances were performed 1 day before reconstruction and 6, 12, 36, and 60 months after surgery, on patients' reconstructed and nonoperated breasts. RESULTS: The average sternal notch-to-nipple distance increased in both reconstructed and nonoperated breasts at every follow-up visit, with an average difference of 0.393 cm at the 60-month visit (p < 0.0001). Comparing the pattern of distance change, reconstructed breasts tend to change more slowly than nonoperated breasts until 36 months postoperatively. In irradiated breasts, the sternal notch-to-nipple distance was significantly smaller than in nonirradiated breasts, and nipple position changed minimally between 1 and 3 years after surgery. CONCLUSIONS: Nipple position in TRAM flap-reconstructed breasts changed over time compared with that in nonoperated breasts, especially along the vertical axis. The pattern of nipple position change in reconstructed breasts became similar to nonoperated breasts 3 years after surgery. In patients who had undergone adjuvant radiation therapy, nipple position remained consistent for 1 to 3 years. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias da Mama/terapia , Mamoplastia/efeitos adversos , Retalho Miocutâneo/efeitos adversos , Mamilos/anatomia & histologia , Reto do Abdome/transplante , Adulto , Idoso , Feminino , Seguimentos , Humanos , Mamoplastia/métodos , Mastectomia Subcutânea/efeitos adversos , Pessoa de Meia-Idade , Retalho Miocutâneo/transplante , Mamilos/efeitos da radiação , Mamilos/cirurgia , Estudos Prospectivos , Radioterapia Adjuvante/efeitos adversos , Resultado do Tratamento
5.
Plast Reconstr Surg ; 145(2): 340-343, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985617

RESUMO

The history of autologous breast reconstruction has been characterized by the desire for progressively increasing reliability with decreasing donor-site morbidity. The robotic deep inferior epigastric artery perforator flap permits the longest possible pedicle harvest through the smallest possible fascial incision and, for this reason, may be the next stage in the evolution of minimally invasive, autologous breast reconstruction.


Assuntos
Mamoplastia/métodos , Retalho Perfurante , Procedimentos Cirúrgicos Robóticos/métodos , Feminino , Humanos , Pneumoperitônio Artificial/métodos , Reto do Abdome/transplante , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante , Transplante Autólogo
8.
Anticancer Res ; 39(12): 6751-6757, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810940

RESUMO

BACKGROUND/AIM: Our original hypothesis was that the rectus sheath block (RSB) analgesia could enhance patient satisfaction and decrease pain following midline laparotomy. PATIENTS AND METHODS: Initially, 56 patients were randomized into four groups; control group (n=12), single-dose (n=16), repeated-dose (n=12) and continuous infusion (n=16) RSB analgesia groups. The BPI (Brief Pain Inventory) survey was conducted preoperatively and at one and four weeks and 12 months postoperatively. The patients pain 24 h postoperatively and satisfaction 48 h postoperatively was filled on an 11-point numeric rating scale (NRS). RESULTS: The repeated-dose group had lower BPI severity score (p=0.045) and BPI interference score (p=0.043) mean values postoperatively compared to the three other groups separately. Also, the time effect on the linear mixed model in BPI interference score mean values was statistically significant (p=0.008), which means that in the repeated dose group preoperative BPI severity score [2.7 (3.9)] and interference score [4.3 (4.2)] mean (SD) values were significantly higher than the BPI severity score [1.3 (0.8)] and interference score [1.5 (1.8)] mean (SD) values following surgery. CONCLUSION: The higher elevation in BPI severity score and decrease in interference score values in the repeated dose group and also the time effect in a linear mixed model in BPI interference score were statistically significant.


Assuntos
Laparotomia/efeitos adversos , Bloqueio Nervoso/métodos , Medição da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Atividades Cotidianas , Nível de Saúde , Inquéritos Epidemiológicos , Humanos , Laparotomia/métodos , Satisfação do Paciente , Período Pós-Operatório , Estudos Prospectivos , Qualidade de Vida , Reto do Abdome/inervação , Índice de Gravidade de Doença
9.
Medicina (Kaunas) ; 56(1)2019 Dec 25.
Artigo em Inglês | MEDLINE | ID: mdl-31881780

RESUMO

Background and Objectives: Rugby players engage in demanding, high loading muscular activity in the spine. Study of the abdominal wall architecture in female rugby athletes is relevant to the possible muscular asymmetry secondary to sport practice and the relationship between the abdominal wall and the pelvic floor muscles. Activation of the transversus abdominis (TrAb) generates an increase in the bladder neck muscle. Moreover, an increased interrecti distance (IRD) is related to urinary incontinence and has a higher prevalence in athletic women. The aim of the present study was to compare and quantify, with ultrasound imaging (USI), the thickness of the transversus abdominis (TrAb), external oblique (EO), internal oblique (IO), rectus abdominis (RA), and interrecti distance (IRD) in female rugby players versus non-athletic women in order to improve upon existing knowledge about abdominal wall configuration in female athletes. Materials and Methods: A sample of 32 women was recruited at the Universidad Europea Research Lab and divided in two groups: a rugby group (n = 16) and a non-athletic women group (n = 16). The thickness of the TrAb, EO, IO, RA, and IRD were assessed by USI in both groups. Results: There were statistically significant differences for the ultrasound evaluation thickness of the right TrAb (p = 0.011; d = 0.10), EO (p = 0.045; d = 0.74), IO (p = 0.003; d = 1.32), and RA (p = 0.001; d = 1.38) showing a thickness increase for the rugby group with respect to the control group. For the IRD thickness, there were no significant differences (p > 0.05) between groups. Conclusions: An increased TrAb, IO, EO, and RA thickness may be shown in female rugby players versus non-athletic women. Nevertheless, statistically relevant differences were not found for the IRD between both groups.


Assuntos
Parede Abdominal , Futebol Americano/fisiologia , Músculos , Comportamento Sedentário , Músculos Abdominais/crescimento & desenvolvimento , Músculos Abdominais/fisiologia , Músculos Abdominais Oblíquos/crescimento & desenvolvimento , Músculos Abdominais Oblíquos/fisiologia , Adulto , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Reto do Abdome/crescimento & desenvolvimento , Reto do Abdome/fisiologia , Ultrassonografia/métodos , Pesos e Medidas/instrumentação
10.
Sao Paulo Med J ; 137(5): 401-406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721939

RESUMO

BACKGROUND: Sarcopenia may affect patients with liver cirrhosis and worsen disease outcomes. OBJECTIVES: To evaluate ultrasound-measured psoas major (PM) and rectus abdominis (RA) thickness for predicting survival among patients with liver cirrhosis. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: 61 patients with liver cirrhosis were prospectively included during a 15-month period and followed up for at least six months. Cirrhosis was classified using the Child-Pugh score. Sarcopenia was assessed using surrogate parameters: handgrip strength (HGS), mid-arm muscle circumference (MAMC) and SGA (subjective global assessment). We used ultrasound to measure RA and PM thickness at admission. RESULTS: There were 41 men. The patients' mean age was 58.03 ± 10.8 years. 26.22% of them were Child-Pugh A, 45.9% B and 27.86% C. The patients were followed up for 11.9 ± 5.63 months. RA thickness correlated moderately with MAMC (r = 0. 596; P < 0.0001) and HGS (r = 0.515; P < 0.0001) and decreased with increasing SGA class (A, 10.6 ± 2.8 mm; B, 8.3 ± 1.9 mm; C, 6.5 ± 1.9 mm; P < 0.0001). Survival at six months was independently predicted by using the model for end-stage liver disease-serum sodium score (odds ratio, OR 1.305; 95% OR confidence interval 1.083-1.572; P = 0.005). Survival during follow-up was independently predicted by RA thickness (hazard ratio, HR 0.701; 95% HR confidence interval 0.533-0.922; P = 0.011) and ascites (HR 1.876; 95% HR confidence interval 1.078-3.267; P = 0.026). PM thickness did not have any predictive value. CONCLUSIONS: As a surrogate marker of sarcopenia, RA thickness may predict survival among patients with liver cirrhosis.


Assuntos
Cirrose Hepática/complicações , Reto do Abdome/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Idoso , Feminino , Força da Mão , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Romênia/epidemiologia , Sarcopenia/complicações , Índice de Gravidade de Doença , Análise de Sobrevida
11.
J Drugs Dermatol ; 18(11): 1098-1102, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31738500

RESUMO

Objective: This study investigates the effects of high-intensity focused electromagnetic technology for induction of changes in abdominal muscles and abdominal subcutaneous fat. Methods: 22 male and female subjects (aged 34 to 64, mean BMI, 23.5kg/m2) underwent 8 treatments of the abdomen (2 per week) with a high-intensity focused electromagnetic field device. Subjects were scanned by computed tomography (CT) at baseline and 1 month after the eighth treatment. Sub-umbilical and epi-umbilical slices were used to measure the thickness of subcutaneous fat and abdominal muscles and the abdominal separation. In addition, standardized photographs, weight, and circumference measurements were collected. Results: While comparing baseline to follow-up measurements, CT data showed on average 17.5% (-3.1±1.9mm) reduction in subcutaneous fat and simultaneous 14.8% (+1.5±0.8mm) thickening of the rectus abdominis muscle. Subjects lost on average 3.9±3.1cm in the waist circumference. Most of the waist reduction effect was achieved after the fourth treatment. The width of abdominal separation decreased by 9.5% (-2.0±1.7mm). All results were highly significant (P<0.01) while weight change was insignificant (P<0.05). Digital photographs showed aesthetic improvement in most subjects. The treatments were painless and without adverse events. Conclusion: Results suggest that the investigated device is effective for abdominal body sculpting. This technology produced rectus muscle hypertrophy and a reduction in subcutaneous abdominal fat. Data suggests 4 treatments as the ideal protocol delivering 86% of the observed improvement. J Drugs Dermatol. 2019;18(11):1098-1102.


Assuntos
Terapia de Campo Magnético/instrumentação , Sobrepeso , Reto do Abdome/fisiologia , Gordura Subcutânea Abdominal/fisiologia , Adulto , Radiação Eletromagnética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reto do Abdome/diagnóstico por imagem , Gordura Subcutânea Abdominal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Circunferência da Cintura
12.
Afr Health Sci ; 19(2): 2290-2293, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656515

RESUMO

Rivaroxaban is one of the new anti-coagulants that inhibit Factor Xa and rarely cause rectus sheath hematoma and retroperitoneal haemorrhage which are uncommon, life-threatening complications. Here is a case of an elderly patient on rivaroxaban therapy for the stroke prevention in non-valvular atrial fibrillation who developed rectus sheath hematoma and retroperitoneal bleeding.


Assuntos
Inibidores do Fator Xa/efeitos adversos , Hematoma/induzido quimicamente , Hemorragia/induzido quimicamente , Espaço Retroperitoneal , Rivaroxabana/efeitos adversos , Idoso , Fibrilação Atrial/tratamento farmacológico , Feminino , Hematoma/diagnóstico por imagem , Hematoma/terapia , Hemorragia/diagnóstico por imagem , Hemorragia/terapia , Humanos , Reto do Abdome/diagnóstico por imagem , Espaço Retroperitoneal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
Artigo em Inglês | MEDLINE | ID: mdl-31547140

RESUMO

Most of the studies evaluating core muscle activity during exercises have been conducted with healthy participants. The objective of this study was to compare core muscle activity and tolerability of a variety of dynamic and isometric exercises in patients with non-specific low back pain (NSLBP). 13 outpatients (average age 52 years; all with standing or walking work in their current or latest job) performed 3 consecutive repetitions at 15-repetition maximum during different exercises in random order. Surface electromyography was recorded for the rectus abdominis; external oblique and lumbar erector spinae. Patients rated tolerability of each exercise on a 5-point scale. The front plank with brace; front plank and modified curl-up can be considered the most effective exercises in activating the rectus abdominis; with a median normalized EMG (nEMG) value of 48% (34-61%), 46% (26-61%) and 50% (28-65%), respectively. The front plank with brace can be considered the most effective exercise in activating the external oblique; with a nEMG of 77% (60-97%). The squat and bird-dog exercises are especially effective in activing the lumbar erector spinae; with nEMG of 40% (24-87%) and 29% (27-46%), respectively. All the exercises were well tolerated; except for the lateral plank that was mostly non-tolerated. In conclusion; the present study provides a variety of dynamic and isometric exercises; where muscle activity values and tolerability can be used as guide to design evidence-based exercise programs for outpatients with NSCLBP.


Assuntos
Músculos do Dorso/fisiologia , Dor Crônica/terapia , Terapia por Exercício/estatística & dados numéricos , Dor Lombar/terapia , Reto do Abdome/fisiologia , Adulto , Estudos Transversais , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espanha
14.
Ann Ital Chir ; 82019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31366738

RESUMO

BACKGROUND: Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm affecting soft tissues with a not well defined biological behavior. SFT occurs mostly in the pleura and the thorax, while extra-thoracic localization is uncommon and abdominal localization is very rare. Histologically, SFT is a well defined mass with splindle-cell proliferation in collagenous matrix with staghorn vascular network and CD34 reactive. CASE REPORT: A 64 years-old man with a history of recurrent gastric cancer previously treated with total gastrectomy, was admitted with contrast enhanced CT-scan diagnosis of a well demarcated oval mass of 4.8 cm with microcysts, vascularized in the arterial phase and with wash out in the tardive phase, located in the peritoneal side of right rectus abdominis muscle, suspected for metastatic gastric tumor. The patient underwent minilaparotomy and en-bloc excision of the lesion. Histologically the tumor was characterized by a hemangiopericitoma like growth pattern and the immunostaining was positive to CD34, CD99, BCL-2 and Vimentin. The definitive diagnosis was SFT with a proliferation index (Ki-67/MIB-1) <3%. In our case, chemotherapy was not indicated. At the 6-month follow-up, the patient is in good clinical conditions with no recurrence or metastasis. CONCLUSIONS: We reported a rare case of primitive SFT located in peritoneal side of the of right rectus abdominis muscle treated surgically, in a patient previously affected by gastric adenocarcinoma. In this case, SFT showed a benign behaviour during a short term follow-up. Dimensional pattern, histopathological features and curative surgery remain the most important indicators of clinical outcome. KEY WORDS: Abdominal wall, Hemangiopericitoma, SFT, Solitary fibrous tumorSpindle cell.


Assuntos
Neoplasias Abdominais/cirurgia , Segunda Neoplasia Primária/cirurgia , Reto do Abdome/patologia , Tumores Fibrosos Solitários/cirurgia , Neoplasias Abdominais/química , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Biomarcadores Tumorais , Diagnóstico Diferencial , Gastrectomia , Hemangiopericitoma/diagnóstico , Hemangiopericitoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/patologia , Tumores Fibrosos Solitários/química , Tumores Fibrosos Solitários/diagnóstico , Tumores Fibrosos Solitários/patologia , Neoplasias Gástricas/cirurgia
15.
J Plast Reconstr Aesthet Surg ; 72(10): 1653-1660, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31395456

RESUMO

BACKGROUND: During reconstructive surgical procedures, systemic vasopressors are frequently used to maintain normal blood pressure. However, questions have arisen regarding the pharmacologic effects of vasopressors on flap circulation. Many plastic surgeons have expressed concern about the possibility of impaired flap circulation caused by the vasoconstrictive effect of the drugs. However, the opposing argument exists that the increase in mean arterial pressure from vasoactive agents may improve flap perfusion. The purpose of this study was to evaluate the effect of commonly used vasopressors on flap circulation. METHODS: The vertical rectus abdominis myocutaneous (VRAM) island flap was raised in five female pigs (38.2∼40.7 kg). Hemodynamic parameters were measured continuously by a carotid arterial catheter. A bi-directional transonic vascular doppler flow probe and Laser Doppler perfusion monitor (LDPM) unit were applied to record the continuous change in pedicle artery flow and microvascular perfusion following intravenous administration of dopamine (3, 5, 10µg/kg/minute), dobutamine (1.25, 2.5, 5µg/kg/minute), and norepinephrine (0.05, 0.1, 0.2µg/kg/minute). RESULTS: Both microvascular perfusion and pedicle flow were generally proportional to the mean arterial pressure, and all three vasopressors improved flap perfusion and pedicle flow without deleterious effects. Norepinephrine showed the highest microvascular perfusion and dobutamine showed the highest pedicle flow rate. The mean blood pressure was the only statistically significant factor to affect both microvascular perfusion and pedicle flow (p < 0.0001). CONCLUSION: Our results strongly suggest that the foremost three vasopressors can be used for flap surgery without deterioration, and that the maintenance of adequate systemic blood pressure is crucial for good flap circulation.


Assuntos
Dopamina/farmacologia , Retalho Miocutâneo/irrigação sanguínea , Reto do Abdome/cirurgia , Fluxo Sanguíneo Regional/efeitos dos fármacos , Vasoconstritores/farmacologia , Animais , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Feminino , Hemodinâmica/efeitos dos fármacos , Infusões Intravenosas , Fluxometria por Laser-Doppler/métodos , Modelos Animais , Retalho Miocutâneo/transplante , Reto do Abdome/irrigação sanguínea , Medição de Risco , Sensibilidade e Especificidade , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/transplante , Suínos
16.
Rev Gastroenterol Peru ; 39(2): 187-192, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333239

RESUMO

Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.


Assuntos
Fístula Anastomótica/cirurgia , Gastrectomia/métodos , Derivação Gástrica , Neoplasias Gástricas/cirurgia , Retalhos Cirúrgicos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Gastroenterostomia , Humanos , Pessoa de Meia-Idade , Reto do Abdome/transplante
17.
Plast Reconstr Surg ; 144(2): 197e-204e, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31348338

RESUMO

BACKGROUND: Abdominoplasty is one of the top five most commonly performed cosmetic procedures. Whereas widening of the linea alba is a well-accepted consequence of pregnancy, the changes to the rectus abdominis muscles are less well known and thus unappreciated and undertreated. METHODS: After institutional review board approval, the Northwestern Enterprise Data Warehouse identified nulliparous and multiparous women, aged 18 to 45 years, who underwent abdominal computed tomography between 2000 and the present. Measurements included the width and cross-sectional area of each rectus muscle, width of the linea alba, and circumference of the abdominal cavity at the level of the L3 vertebra. In addition, two case reports addressing these anatomical changes with muscle modification and mesh reinforcement are presented. RESULTS: Sixty women were identified that met our inclusion criteria: 15 nulliparous, 15 after one pregnancy (para 1), 15 after two pregnancies (para 2), and 15 after three or more pregnancies (para ≥ 3). The linea alba was significantly widened after one pregnancy from 1.14 cm to 2.29 cm, but did not significantly widen further with each subsequent pregnancy. The width of each rectus muscle was significantly widened from 6.00 ± 0.60 cm in nulliparous to 6.61 ± 0.58 cm in para 1, significantly widened again to 7.03 ± 0.46 cm in para 2, but not significantly widened after that (6.97 ± 1.00 cm in para 3). CONCLUSIONS: In addition to widening of the linea alba, pregnancy alters the shape of the rectus abdominis muscle. Correction of muscle width during abdominoplasty may be a necessary adjunct to achieve the proper tension in both primary and revision procedures. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Abdominoplastia/métodos , Abdominoplastia/estatística & dados numéricos , Reto do Abdome/diagnóstico por imagem , Reto do Abdome/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/cirurgia , Adulto , Estudos de Coortes , Bases de Dados Factuais , Estética , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Paridade , Satisfação do Paciente/estatística & dados numéricos , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Estados Unidos , Adulto Jovem
18.
Crit Care ; 23(1): 261, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340846

RESUMO

BACKGROUND: For every day a person is dependent on mechanical ventilation, respiratory and cardiac complications increase, quality of life decreases and costs increase by > $USD 1500. Interventions that improve respiratory muscle function during mechanical ventilation can reduce ventilation duration. The aim of this pilot study was to assess the feasibility of employing an abdominal functional electrical stimulation (abdominal FES) training program with critically ill mechanically ventilated patients. We also investigated the effect of abdominal FES on respiratory muscle atrophy, mechanical ventilation duration and intensive care unit (ICU) length of stay. METHODS: Twenty critically ill mechanically ventilated participants were recruited over a 6-month period from one metropolitan teaching hospital. They were randomly assigned to receive active or sham (control) abdominal FES for 30 min, twice per day, 5 days per week, until ICU discharge. Feasibility was assessed through participant compliance to stimulation sessions. Abdominal and diaphragm muscle thickness were measured using ultrasound 3 times in the first week, and weekly thereafter by a blinded assessor. Respiratory function was recorded when the participant could first breathe independently and at ICU discharge, with ventilation duration and ICU length of stay also recorded at ICU discharge by a blinded assessor. RESULTS: Fourteen of 20 participants survived to ICU discharge (8, intervention; 6, control). One control was transferred before extubation, while one withdrew consent and one was withdrawn for staff safety after extubation. Median compliance to stimulation sessions was 92.1% (IQR 5.77%) in the intervention group, and 97.2% (IQR 7.40%) in the control group (p = 0.384). While this pilot study is not adequately powered to make an accurate statistical conclusion, there appeared to be no between-group thickness changes of the rectus abdominis (p = 0.099 at day 3), diaphragm (p = 0.652 at day 3) or combined lateral abdominal muscles (p = 0.074 at day 3). However, ICU length of stay (p = 0.011) and ventilation duration (p = 0.039) appeared to be shorter in the intervention compared to the control group. CONCLUSIONS: Our compliance rates demonstrate the feasibility of using abdominal FES with critically ill mechanically ventilated patients. While abdominal FES did not lead to differences in abdominal muscle or diaphragm thickness, it may be an effective method to reduce ventilation duration and ICU length of stay in this patient group. A fully powered study into this effect is warranted. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry, ACTRN12617001180303. Registered 9 August 2017.


Assuntos
Estimulação Elétrica/métodos , Desmame do Respirador/instrumentação , APACHE , Adulto , Idoso , Estado Terminal/epidemiologia , Estado Terminal/terapia , Método Duplo-Cego , Estimulação Elétrica/instrumentação , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Reto do Abdome/irrigação sanguínea , Reto do Abdome/fisiopatologia , Desmame do Respirador/métodos , Desmame do Respirador/normas
19.
Anaesthesiol Intensive Ther ; 51(2): 83-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268267

RESUMO

BACKGROUND: Rectus sheath block (RSB) is a valuable regional technique for abdominal wall midline analgesia. It can be used for a variety of surgical procedures such as midline laparotomy, umbilical and paraumbilical hernia repair, and laparoscopic surgery. Not all operating theatres, especially in low income countries, are equipped with ultrasound (US) scanners for carrying out US guided regional blocks. In cases of total absence of objective control, neurostimulator (NS) guided technique of RSB can be useful. The aim of the study was to assess the feasibility of performing NS guided RSB. METHODS: US guided RSB with NS was performed on patients in group 1. NS guided RSB was performed on patients in group 2. US scanning of block area and clinical efficacy assessment were performed in group 2. RESULTS: In group 1 in all cases of US guided RSB with NS, needle entry into the rectus abdominis muscle resulted in its contractions and needle contact with the posterior sheath resulted in cessation of these contractions. In group 2 optimal spread of local anesthetic was achieved in 86 cases (74.14%), and suboptimal spread in 30 cases (25.86%) of NS guided RSB. There were no cases of non-optimal local anesthetic spread. In all cases NS guided RSB had high clinical efficacy (there was no motor response to incision and no need for fentanyl administration). CONCLUSIONS: Rectus sheath block can be performed under neurostimulator guidance. Neurostimulator guided rectus sheath block results in optimal or suboptimal local anes-thetic spread. Clinical efficacy of neurostimulator guided rectus sheath block is high. The trial is registered as ACTRN12618000553279 (http://www.ANZCTR.org.au/ACTRN12618 000553279.aspx).


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Criança , Pré-Escolar , Estimulação Elétrica/métodos , Estudos de Viabilidade , Feminino , Humanos , Lactente , Masculino , Reto do Abdome
20.
Medicine (Baltimore) ; 98(28): e16395, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305447

RESUMO

RATIONALE: The main cause of death in melanoma patients is widespread metastases as it can metastasize to almost every organ. However, melanoma skeletal muscle metastases (MSMM) are exceptional, and only a few cases of MSMM to the rectus abdominis muscles have been previously described. And our case maybe the first reported case in Asia region. PATIENT CONCERNS: A 45-year-old man with history of right scalp melanoma, pT3aN0M0, stage IIA status post wide excision with 2 cm safe margin and right neck lymph node dissection at 5 years before. He had an almost 5 years disease-free period but presented to our clinic due to intermittent abdominal sharp pain for 1 to 2 months, with a palpable soft tissue mass over his right abdomen. Metastatic melanoma to rectus abdominis muscles was highly suspected. INTERVENTIONS: The patient subsequently underwent radical en-block extraperitoneal 15 cm segmental resection of the right rectus abdominis muscle including tumor mass. The resected tumor was a black-gray colored solid mass, and the final histologic study showed a metastasis of melanoma. OUTCOMES: Postoperative course of the patient was uneventful, and the right abdominal pain was improved. The patient was referred for further target therapy, but passed away half a year later due to multiple metastasis. LESSONS: Scalp melanoma with isolated rectus muscle metastasis is extremely rare especially for a young aged patient who had an almost 5-year disease-free period. Surgery is a potentially curative therapy for patients with isolated metastatic melanoma. The goal is negative resection margins, in order to avoid local recurrences. Radical compartmental surgery should be considered for selected stage IV melanoma patients with sole rectus abdominis MSMM, whose disease could be amenable to complete resection, in preliminary procedure to prolong disease-free survival time. For oligometastatic disease, surgical resection is sometimes useful in carefully selected patients after systemic therapy; also, it could be performed as symptomatic treatment.


Assuntos
Neoplasias Abdominais/secundário , Neoplasias de Cabeça e Pescoço/patologia , Melanoma/patologia , Neoplasias Musculares/secundário , Neoplasias Cutâneas/patologia , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/cirurgia , Evolução Fatal , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Melanoma/diagnóstico , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Musculares/diagnóstico , Neoplasias Musculares/cirurgia , Reto do Abdome , Couro Cabeludo , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia
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