Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function.

OBJECTIVE: To compare two thoracotomy closure techniques (pericostal and transcostal suture) in terms of postoperative pain and pulmonary function. METHODS: This was a prospective, randomized, double-blind study carried out in the Department of Thoracic Surgery of the Luzia de Pinho Melo Hospital das Clínicas and at the University of Mogi das Cruzes, both located in the city of Mogi das Cruzes, Brazil. We included 30 patients (18-75 years of age) undergoing posterolateral or anterolateral thoracotomy. The patients were randomized into two groups by the type of thoracotomy closure: pericostal suture (PS; n = 16) and transcostal suture (TS; n = 14). Pain intensity during the immediate and late postoperative periods was assessed by a visual analogic scale and the McGill Pain Questionnaire. Spirometry variables (FEV1, FVC, FEV1/FVC ratio, and PEF) were determined in the preoperative period and on postoperative days 21 and 60. RESULTS: Pain intensity was significantly greater in the PS group than in the TS group. Between the preoperative and postoperative periods, there were decreases in the spirometry variables studied. Those decreases were significant in the PS group but not in the TS group. CONCLUSIONS: The patients in the TS group experienced less immediate and late post-thoracotomy pain than did those in the PS group, as well as showing smaller reductions in the spirometry parameters. Therefore, transcostal suture is recommended over pericostal suture as the thoracotomy closure technique of choice.

Comparison between two thoracotomy closure techniques: postoperative pain and pulmonary function / Comparação entre duas técnicas de fechamento de toracotomia: dor pós-operatória e função pulmonar

OBJECTIVE: To compare two thoracotomy closure techniques (pericostal and transcostal suture) in terms of postoperative pain and pulmonary function. METHODS: This was a prospective, randomized, double-blind study carried out in the Department of Thoracic Surgery of the Luzia de Pinho Melo Hospital das Clínicas and at the University of Mogi das Cruzes, both located in the city of Mogi das Cruzes, Brazil. We included 30 patients (18-75 years of age) undergoing posterolateral or anterolateral thoracotomy. The patients were randomized into two groups by the type of thoracotomy closure: pericostal suture (PS; n = 16) and transcostal suture (TS; n = 14). Pain intensity during the immediate and late postoperative periods was assessed by a visual analogic scale and the McGill Pain Questionnaire. Spirometry variables (FEV1, FVC, FEV1/FVC ratio, and PEF) were determined in the preoperative period and on postoperative days 21 and 60. RESULTS: Pain intensity was significantly greater in the PS group than in the TS group. Between the preoperative and postoperative periods, there were decreases in the spirometry variables studied. Those decreases were significant in the PS group but not in the TS group. CONCLUSIONS: The patients in the TS group experienced less immediate and late post-thoracotomy pain than did those in the PS group, as well as showing smaller reductions in the spirometry parameters. Therefore, transcostal suture is recommended over pericostal suture as the thoracotomy closure technique of choice. .

OBJETIVO: Comparar duas técnicas de fechamento de toracotomias (sutura pericostal e transcostal) em relação à dor pós-operatória e função pulmonar. MÉTODOS: Estudo prospectivo, randomizado e duplo-cego realizado no Serviço de Cirurgia Torácica do Hospital das Clínicas Luzia de Pinho Melo e na Universidade de Mogi das Cruzes, na cidade de Mogi das Cruzes, Brasil. Foram incluídos no estudo 30 pacientes submetidos a toracotomias posterolaterais ou anterolaterais, com idade entre 18 e 75 anos. Os pacientes foram randomizados em dois grupos em função do tipo de fechamento da toracotomia: sutura pericostal (SP; n = 16) e sutura transcostal (ST; n = 14). A intensidade da dor no pós-operatório imediato e tardio foi avaliada por uma escala visual analógica e questionário de dor McGill. Foram avaliadas variáveis espirométricas (VEF1, CVF, relação VEF1/CVF e PFE) no pré-operatório e nos 21º e 60º dias pós-operatórios. RESULTADOS: A intensidade da dor foi significativamente maior no grupo SP que no grupo ST. No grupo SP, houve reduções significativas nas variáveis espirométricas estudadas entre o período pré-operatório e pós-operatório. Essas reduções não foram significativas no grupo ST. CONCLUSÕES: Os pacientes no grupo ST apresentaram menor intensidade de dor pós-toracotomia, tanto imediata como tardia, e menor redução nos parâmetros espirométricos que os no grupo SP. Dessa forma, a técnica de fechamento de toracotomia por sutura transcostal é recomendada por apresentar vantagens sobre a técnica pericostal tradicional. .

Development and Validation of a Virtual Environment to Evaluate the Capacity in Executing the Safety Procedures in Recreational Scuba Diving.

BACKGROUND: Recreational scuba diving courses have safety procedures in their curriculum to be followed in case of emergencies. However, the actual diving is often performed months after the training. Because these procedures are counterinstinctive, when emergencies occur the divers in panic cannot follow them. MATERIALS AND METHODS: Thus a virtual environment was developed, presenting several emergency situations that may occur during a recreational dive. It used an Intel(®) (Santa Clara, CA) Core™2 Duo (1.66 GHz, 1 GB RAM) PC and Adobe (San Jose, CA) Fireworks and Adobe Flash 8 for animation and programming. The procedures to be followed were the standards of the Association of Dive Schools. RESULTS AND CONCLUSION: This research found that the performance of divers on a questionnaire on diving safety procedures is very different than in the virtual environment.

Estudo comparativo das técnicas de segmentaçäo de microcalcificaçöes em imagens mamográficas / Comparative study of microcalcifications segmentation thechnical in mammographic images

No intuito de comparar os resultados apresentados na literatura de várias técnicas de segmentaçäo de microcalcificaçöes mamográficas, selecionamos as técnicas que aparentemente apresentavam os melhores resultados a saber: 'threshold', crescimento de regiäo e filtros gaussianos combinados com operadores morfológicos. Processamos as imagens, de um mesmo banco de dados, digitalizadas com o mesmo dispositivoe comparamos os resultados obtidos. Além disso baseados nesta comparaçäo desenvolvemos um algorítmo híbrido que aproveita parte das técnicas mais eficientes apresentadas para segmentar as microcalcificaçöes com um desempenho superior.