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1.
Surg Clin North Am ; 100(6): 1079-1089, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33128881

RESUMO

Advanced colonic polypectomy techniques are endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), and they aim at organ preservation with low complication rates. Main goal of endoscopic submucosal dissection (ESD) is to accomplish en-bloc resection that will subsequently allow accurate histopathological evaluation. It consists of injection, circumferential incision, and dissection of the lesion. Steps of the procedure are discussed in detail along with technological advancements.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia/métodos , Ressecção Endoscópica de Mucosa/métodos , Pólipos do Colo/patologia , Dissecação/métodos , Humanos , Mucosa Intestinal/patologia , Mucosa Intestinal/cirurgia
2.
Eur. j. anat ; 24(4): 277-280, jul. 2020. ilus
Artigo em Inglês | IBECS | ID: ibc-193960

RESUMO

Many muscular variations of the upper extremity have been reported. The majority of these variations are associated with forearm muscles. However, the muscular variations of the hand are uncommon. In the current study we found a unique supernumerary muscle in the right hand of a middle-aged male cadaver. This muscle originated from the one of the tendons of flexor digitorum superficialis (FDS) muscle that goes to the index finger and then traversed 5 cm distally to attach the same tendon. The knowledge of muscular variations is very essential for surgeons and clinicians to plan the standard surgical approaches


No disponible


Assuntos
Humanos , Mãos/anatomia & histologia , Mãos/inervação , Cadáver , Músculos/anatomia & histologia , Dissecação/métodos , Variação Anatômica
3.
Plast Reconstr Surg ; 146(1): 11e-22e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590636

RESUMO

BACKGROUND: The anatomical descriptions of the attachments of the female breast to the chest wall vary in their structure, location, and terminology within the published literature. METHODS: A dissection study of the attachments of the breast to the chest wall was conducted on 18 female embalmed breasts in the coronal (n = 15) and sagittal planes (n = 3). RESULTS: Perimeter, posterior wall, and horizontal septum attachments were observed. The perimeter along its entire length was attached to the chest wall. Regional and anatomical variation was observed in this structure and location. Sharp dissection was required to remove it from the chest wall, in contrast to the blunt dissection required to remove the posterior wall and horizontal septum attachments. CONCLUSIONS: The breast attaches to the chest wall along its entire perimeter, posterior wall, and horizontal septum, with the perimeter functioning as the primary anchor of the breast to the chest wall. The structure of the perimeter attachment is both periosteal and fascial and requires sharp dissection to remove it from the chest wall. The fascial structures of the posterior wall and horizontal septum require blunt dissection only. The structure of the perimeter has regional variation, and its location on the chest wall has anatomical variation. Detailed anatomical descriptions and illustrations are supported by photographic evidence of cadaver dissections in two planes. Clinical and anatomical terminology are linked, with clinical implications for medical anatomy education, breast modeling, and breast surgery.


Assuntos
Mama/anatomia & histologia , Parede Torácica/anatomia & histologia , Idoso , Idoso de 80 Anos ou mais , Mama/cirurgia , Cadáver , Dissecação/métodos , Feminino , Humanos , Parede Torácica/cirurgia
4.
Chirurgia (Bucur) ; 115(2): 220-226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369726

RESUMO

Specific risk factors for gastroduodenal surgery in cirrhotic patients have been identified, which dictates for a more personalized management. The retrospective study was conducted between 2012-2019 on twelve patients (7 cases of duodenal ulcer, 2 cases of gastric ulcer and 3 patients with gastric cancer). We took into account a number of possible factors involved in the unfavorable evolution of patients, based on data published in the literature so far. In order to follow the involvement of each factor we compared two groups of patients, one with unfavorable evolutions, exitus and another with favorable evolutions. Emergency surgery, the presence of ascites at the time of intervention, a higher than 30 MELD score, alcoholic cirrhosis, liver encephalopathy and liver failure are common factors that are found in a high percentage (between 75% and 100%) in patients who have had an unfavorable evolution, exitus. The same risk factors are found in much lower percentages in patients who have evolved favorably postoperatively, most between 12.5% and 25%. We analyzed preoperative aspects, surgical approach, complications and risk factors for these patients, compared them with the results of our study and identified future therapeutic possibilities. For CHILD B or C patients, the indication for surgery should be discussed in advance with a multidisciplinary team. Endoscopic submucosal dissection or discontinuation of D2 dissection should be considered in these patients.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Úlcera Duodenal/cirurgia , Cirrose Hepática/complicações , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Dissecação/efeitos adversos , Dissecação/métodos , Úlcera Duodenal/complicações , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Úlcera Gástrica/complicações
5.
J Clin Neurosci ; 77: 55-61, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409218

RESUMO

It is commonly known that brain metastases usually have clear boundaries in magnetic resonance imaging. However, little is known regarding the trajectory of white matter fibers around the tumors, especially using the fiber dissection technique. Here, we focused on the anatomical interaction between white matter fibers and the tumor, using the fiber dissection in a postmortem brain with metastatic tumor and compared the findings with those of diffusion tensor imaging (DTI) tractography. One postmortem human brain hemisphere with metastatic adenocarcinoma in the Broca's area was dissected using fiber dissection following the Klingler's method. In order to compare the in vitro and in vivo results, additional brains from 15 patients with metastatic adenocarcinomas, the volumes of which were comparable to that of the adenocarcinoma in the brain used for fiber dissection, were analyzed using DTI tractographic reconstruction. Morphological findings of white matter bundles running around the tumor were compared between the two techniques. In the fiber dissection technique, the superior longitudinal fascicle, arcuate fascicle, and frontal aslant tract could be dissected, and the white matter bundles were curved and retracted to avoid the tumor. In all the cases analyzed, white matter fibers or streamlines surrounding the tumor avoided the lesion. Using the fiber dissection technique, this is the first direct evidence to elucidate the anatomy of white matter fibers affected by a metastatic brain. This suggests that brain metastatic adenocarcinoma is an intra-axial neoplasm with extra-axial white matter structures.


Assuntos
Adenocarcinoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Imagem de Tensor de Difusão/métodos , Microdissecção/métodos , Fibras Nervosas Mielinizadas , Substância Branca/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Dissecação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/patologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/patologia , Vias Neurais/cirurgia , Substância Branca/patologia , Substância Branca/cirurgia
6.
Khirurgiia (Mosk) ; (3): 5-12, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271731

RESUMO

AIM: To improve the results of treatment of patients with focal liver formations by preventing the development of postoperative complications after liver resections. METHODS: The study included 304 patients with benign and malignant liver lesions. In 196 (64.4%) patients, resections were performed for malignant liver damage, in 108 (35.6%) - for a benign process. To assess the impact of ongoing measures to prevent the development of postoperative complications, patients were divided into two time periods: from 2007 to 2012 and from 2013 to 2018. RESULTS: The introduction of a protocol of preoperative examination of patients for whom resection of 3 or more liver segments is planned, with the inclusion of SPECT/CT, which allows determining the volume of the remaining functioning liver parenchyma, allowed to reduce the percentage of development of acute post-resection liver failure from 11.6% to 3.6% during the second time period (p=0.0064). The use of modern suture material, surgical binocular loops, as well as the use of the concept of predominantly performing parenchyma-saving resections, reduced the number of biliary complications from 8.1% to 5.7% (p=0.1). The use of a proprietary dissection algorithm for the liver parenchyma significantly reduced hemorrhagic complications from 5.3% to 1.04% (p=0.0074). CONCLUSION: The use of modern pre- and intraoperative technologies has reduced the number of postoperative complications after liver resections from 38.3% to 20.9% (p=0.018) and mortality from 2.6% to 0.5% (p=0.004), thereby improving the results of liver resections.


Assuntos
Hepatectomia/efeitos adversos , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Fígado/cirurgia , Algoritmos , Doenças Biliares/etiologia , Doenças Biliares/prevenção & controle , Perda Sanguínea Cirúrgica/prevenção & controle , Protocolos Clínicos , Dissecação/efeitos adversos , Dissecação/métodos , Hepatectomia/instrumentação , Hepatectomia/mortalidade , Humanos , Fígado/diagnóstico por imagem , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Falência Hepática/etiologia , Falência Hepática/prevenção & controle , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/prevenção & controle , Neoplasias Hepáticas/diagnóstico por imagem , Tamanho do Órgão , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Técnicas de Sutura/instrumentação
7.
Artigo em Chinês | MEDLINE | ID: mdl-32306638

RESUMO

Objective: To compare intact dissection and segmented dissection of cochlear surface preparation in adult mice. Methods: From February to March, 2019, Six adult C57BL/6 mice were randomly divided into 2 groups: one group (3 mice) for the intact dissection while the other group (3 mice) for the segmented dissection. Cochlear hair cells were labeled with phalloidin for evaluation of the integrity of the basilar membrane. Results: The basilar membranes can be completely dissected from the cochlea by two approaches. The average dissection time is (16.33±1.86)min with the intact dissection approach while (23.66±3.88) min with the segmented dissection(t=-4.173, P=0.002). Immunofluorescence analysis showed all cochlear hair cells werevisible and intact in two groups. Conclusion: Cochlear basilar membrane can be dissected intact in a short time through both approaches. The approaches selection is dependent on the purpose of experiment and operators' experience.


Assuntos
Membrana Basilar/anatomia & histologia , Cóclea/anatomia & histologia , Dissecação/métodos , Animais , Imunofluorescência , Células Ciliadas Auditivas , Camundongos , Camundongos Endogâmicos C57BL , Distribuição Aleatória
8.
J Vis Exp ; (157)2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32250354

RESUMO

Surgery for laryngeal malignancies requires millimetric accuracy from the different endoscopic and open techniques available. Practice of this surgery is almost completely reserved to a few referral centers that deal with a large proportion of this pathology. Practice on human specimens is not always possible for ethical, economic, or availability reasons. The aim of this study is to provide a reproducible method for the organization of a laryngeal laboratory on ex vivo animal models where it is possible to approach, learn, and refine laryngeal techniques. Porcine and ovine larynges are ideal, affordable, models to simulate laryngeal surgery given their similarity to the human larynx in their anatomical layout and tissue composition. Herein, the surgical steps of transoral laser surgery, open partial horizontal laryngectomy, and total laryngectomy are reported. The merging of endoscopic and exoscopic views guarantees an inside-out perspective, which is vital for the comprehension of the complex laryngeal anatomy. The method was successfully adopted during three sessions of a dissection course "Lary-Gym". Further perspectives on robotic surgical training are described.


Assuntos
Dissecação/educação , Laringe/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Animais , Dissecação/métodos , Laringe/anatomia & histologia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Robóticos/educação , Ovinos , Treinamento por Simulação , Suínos
9.
World Neurosurg ; 138: e859-e866, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32251832

RESUMO

OBJECTIVE: The minipterional approach (MPTa) has been widely accepted as a minimally invasive technique in the treatment of anterior and middle cranial fossa lesions. However, this craniotomy does not facilitate exposure of the distal sylvian fissure or wide sylvian dissection. We have described a modification of the MPTa, the extended minipterional approach (eMPTa), which results in improved access to the distal sylvian fissure with minimal additional bony removal. We have defined the ideal posterior landmark for this craniotomy, the preauricular line, using an anatomic cadaveric study. METHODS: The insular and sylvian exposure offered by the MPTa and eMPTa were compared in 5 cadaveric heads. Anatomic exposure of the eMPTa and its anatomic relation to different landmarks were also evaluated. RESULTS: The eMPTA, extending posteriorly to the preauricular line, offers improved surgical exposure of the sylvian fissure (30.5 vs. 13 mm; P < 0.001) and insula (31 vs. 10 mm; P < 0.001) compared with the MPTa. The frontal precentral artery, an important landmark for performing distal-to-proximal sylvian dissection, is 17 ± 5.2 mm anterior to the preauricular line, the posterior limit of the eMPTa. In contrast, it is 6.5 ± 3.6 mm posterior to the traditional posterior limit of the MPTa. CONCLUSION: The eMPTA offers improved access to the sylvian fissure, allowing for wider fissure splitting and only requiring extension of the posterior limit of the MPT craniotomy up to the preauricular line. This could allow for improved freedom of movement deep in the sylvian cistern and potentially expand the indications of the MPTa.


Assuntos
Córtex Cerebral/cirurgia , Craniotomia/métodos , Dissecação/métodos , Córtex Cerebral/irrigação sanguínea , Fossa Craniana Anterior/cirurgia , Fossa Craniana Média/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos
10.
Arq. bras. oftalmol ; 83(2): 87-91, Mar.-Apr. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1088975

RESUMO

ABSTRACT Purpose: The present study's aim was to compare the biomechanical properties of corneal tissue in patients who underwent deep anterior lamellar keratoplasty (DALK) surgery, with successful big bubble formation and manual lamellar dissection, during failed big bubble formation. Methods: This retrospective comparative study included 60 eyes from 60 keratoconus patients who previously underwent DALK surgery. These patients were categorized as big bubble (+) or big bubble (−) based on the success or failure of big bubble formation during the surgery. The big bubble (+) group included 42 eyes, while the big bubble (−) group had 18 eyes. Moreover, the patients were regrouped as 0.25 mm and 0.50 mm to evaluate the effects of the disparity between donor and trephine punches on the biomechanical properties of the cornea. These biomechanical properties, characterized by corneal hysteresis and the corneal resistance factor, were measured using the Ocular Response Analyzer 12 months after the surgery. Results: There was no statistically significant difference between the big bubble (+) and big bubble (−) groups in the biomechanical properties of the cornea (corneal hysteresis: 10.06, 10.25; p=0.716/corneal resistance factor: 10.15, 10.07; p=0.805, respectively). In addition, pachymetry results were not statistically different between the two groups. Multivariate regression analysis revealed that corneal hysteresis and corneal resistance factor were positively associated with central corneal thickness (p<0.001/r2=0.506; p<0.001/r2=0.561, respectively). However, the study did not demonstrate a relationship between any of the punch sizes and corneal hysteresis or between the punch sizes (p=0.673) and the corneal resistance factor (p=0.643). Conclusions: The corneal hysteresis and corneal resistance factor values were similar in big bubble and manual lamellar dissection after DALK. Thus, manual lamellar dissection was not a disadvantage considering the cornea's biomechanical properties.


RESUMO Objetivo: O objetivo do estudo foi comparar pa râmetros biomecânicos corneanos de pacientes com cirurgia de ceratoplastia lamelar anterior profunda com formação bem-sucedida de bolha e dissecção lamelar manual, frente à falha de formação da grande bolha. Métodos: Este estudo comparativo retrospectivo incluiu 60 olhos de 60 pacientes com ceratocone submetidos à cirurgia de ceratoplastia lamelar anterior profunda. Os pacientes foram agrupados como grande bolha (+) e grande bolha (-) de acordo com o sucesso da formação da grande bolha durante a cirurgia. O grupo grande bolha (+) incluiu 42 olhos, enquanto o grupo grande bolha (-) tinha 18 olhos. Além disso, para a avaliação dos efeitos da disparidade entre alterações individuais nas propriedades biomecânicas da córnea, reagrupamos os pacientes em 0,25 mm e 0,50 mm. Parâmetros biomecânicos da córnea, caracterizados por histerese corneana e fator de resistência corneana foram medidos com o ORA 12 meses após a cirurgia. Resultados: Não houve diferença estatisticamente significativa entre os grupos grande bolha (+) e grande bolha (-) em relação aos parâmetros biomecânicos da córnea (histerese corneana: 10,06, 10,25, p=0,716/fator de resistência da córnea: 10,15, 10,07, p=0,805, respectivamente). Além disso, os resultados de paquimetria não diferiram estatisticamente entre os dois grupos. A análise de regressão multivariada demonstrou que a histerese da córnea e o fator de resistência corneana estavam associados positivamente com a espessura corneana central (p<0,001/r2=0,506, p<0,001/r2=0,561 respectivamente). No entanto, o estudo não revelou associação entre qualquer um dos tamanhos de punção e histerese corneana, bem como entre os tamanhos de punção e o fator de resistência corneano (p=0,673, p=0,643). Conclusões: A histerese da córnea e os valores do fator de resistência da córnea foram comparáveis com formação de grande bolha e dissecção manual lamelar na ceratoplastia lamelar anterior profunda. Assim, a dissecção manual lamelar não foi uma desvantagem, considerando os fatores biomecânicos da córnea.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Transplante de Córnea/métodos , Córnea/cirurgia , Ceratocone/cirurgia , Valores de Referência , Fenômenos Biomecânicos , Análise Multivariada , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento , Córnea/fisiopatologia , Dissecação/métodos , Ceratocone/fisiopatologia
11.
Ann Thorac Surg ; 110(1): 258-264, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32171731

RESUMO

BACKGROUND: The perioperative outcomes of the use of stapling devices versus electrocautery to dissect intersegmental planes in patients undergoing segmentectomy for small pulmonary lesions is still unclear. The aim of this randomized controlled trial was to compare the perioperative outcomes of these two methods. METHODS: A single-center, prospective, participant-blinded, randomized controlled trial (NCT03192904) was conducted with a preplanned sample size of 136. The primary outcome was the incidence of postoperative complications. Secondary outcomes included duration of operation, blood loss during operation, first-day drainage volume, duration of drainage, postoperative hospital stay, loss of lung function, and medical costs. RESULTS: The trial was stopped early as a result of a marked difference in the primary outcome between groups at a scheduled interim check of the data after recruiting 70 patients. The incidence of postoperative complications (eg, air leakage) was higher in the electrocautery group than in the stapler device group (11/32, 34.4% vs 2/33, 6.1%, P = .004). There were no differences in duration of operation, blood loss during operation, first-day drainage volume, duration of drainage, postoperative hospital stays, loss of lung function, or total medical cost, although the per-patient cost of medical materials was higher in the stapler device group (US$4214.6 ± 1185.4 vs $3260.1 ± 852.6, P < .001). CONCLUSIONS: Among patients undergoing segmentectomy, the use of stapler devices to divide intersegmental planes decreased postoperative complications without further compromising lung function or increasing economic burden.


Assuntos
Dissecação/métodos , Eletrocoagulação/efeitos adversos , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Grampeamento Cirúrgico/efeitos adversos , Adulto , Dissecação/efeitos adversos , Dissecação/instrumentação , Eletrocoagulação/instrumentação , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonectomia/efeitos adversos , Pneumonectomia/instrumentação , Estudos Prospectivos , Grampeadores Cirúrgicos
13.
Pain Physician ; 23(2): E175-E183, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214296

RESUMO

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, which results from median nerve compression. A lot of nonsurgical modalities are available for the management of mild to moderate situations. Local Hyalase hydrodissection (HD) of the entrapped median nerve could offer a desirable sustained symptom alleviation. OBJECTIVES: To evaluate the clinical efficacy of Hyalase/saline solution carpal tunnel HD on pain, functional status, and nerve conduction in patients with CTS. STUDY DESIGN: A randomized, double-blinded trial. SETTING: Anesthesia, pain, and rheumatology clinics in a university hospital. METHODS: Patients: 60 patients with CTS (> 6 months' duration). INTERVENTION: patients were allocated equally into either group 1 (HD with Hyalase + 10 mL saline solution injection), or group 2 (HD with 10 mL saline solution only). MEASUREMENTS: assessment of pain using Visual Analog Scale (VAS), functional disability (FD) score, and nerve conduction studies before injection, and over 6 months after injection. Nerve conduction parameters before injection and postinjection by the end of 3 and 6 months were evaluated as well. RESULTS: Statistically significant lower postinjection values of VAS (1 ± 1.8, 2 ± 1.1, 2 ± 1.2, 2 ± 1.1) in group 1 versus (2 ± 1.2, 3 ± 1.7, 4 ± 1.5, 5 ± 2.6) in group 2 by the end of the first week, and the first, third, and sixth months, and significantly lower FD scores (15.3 ± 1.2, 13 ± 1.3, 10.2 ± 1.3, 10.2 ± 1.3) in group 1 versus (17.5 ± 1.8, 16.6 ± 2.8, 19.4 ± 3.2, 21.2 ± 2.5) in group 2 during the same time intervals. Nerve conduction study parameters have shown significantly higher velocity and lower latency in the Hyalase group than in the saline solution group by the 3 and 6 month follow-up. LIMITATION: We suggest a longer period could be reasonable. CONCLUSIONS: Carpal tunnel HD with Hyalase with saline solution is considered as an efficient technique offering a rapid onset of pain relief and functional improvements, and better median nerve conduction in patients with CTS over 6 months follow-up duration. KEY WORDS: Carpal tunnel syndrome, Hyalase, median nerve hydrodissection.


Assuntos
Síndrome do Túnel Carpal/diagnóstico por imagem , Síndrome do Túnel Carpal/cirurgia , Dissecação/métodos , Ultrassonografia de Intervenção/métodos , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Nervo Mediano/diagnóstico por imagem , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Manejo da Dor/métodos , Resultado do Tratamento , Punho/diagnóstico por imagem , Punho/inervação , Punho/cirurgia
14.
Eur. j. anat ; 24(2): 79-87, mar. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-191235

RESUMO

Typically the retro-mandibular vein contributes to formation of common facial and external jugular veins, via its anterior and posterior divisions respectively. However, cervico-facial venous variants are rather common. In two successive cadaver dissections the left side of head and neck were unviewable, but the right cervico-facial veins were visible. In both cadavers the right retro-mandibular vein was undivided. The first specimen had right external jugular vein draining into the right subclavian vein but did not have a right common facial vein. The second specimen did not have a right external jugular vein, but had a right common facial vein draining into the right internal jugular vein.The first variant was characterized as Posterior Dominant Retromandibular Vein with no Common Facial Vein. The second variant was characterized as Anterior Dominant Retromandibular Vein with no External Jugular Vein. Each was sub-classified as Typical or Atypical based on its final drainage pattern. Cervico-facial venous variants often vary from case to case and side to side. Since external jugular and common facial veins are used for clinical and surgical interventions, accurate and structured preoperative classification of variations may preclude intra-operative surprises and consequentcomplications


No disponible


Assuntos
Humanos , Masculino , Feminino , Dissecação/métodos , Mandíbula/anatomia & histologia , Mandíbula/irrigação sanguínea , Veias Jugulares/anatomia & histologia , Cadáver
15.
J Laryngol Otol ; 134(3): 197-204, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114992

RESUMO

BACKGROUND: Cold dissection is the most commonly used tonsillectomy technique, with low post-operative haemorrhage rates. Coblation is an alternative technique that may cause less pain, but could have higher post-operative haemorrhage rates. OBJECTIVE: This study evaluated the peri-operative outcomes in paediatric tonsillectomy patients by comparing coblation and cold dissection techniques. METHODS: A systematic review was conducted of all comparative studies of paediatric coblation and cold dissection tonsillectomy, up to December 2018. Any studies with adults were excluded. Outcomes such as pain, operative time, and intra-operative, primary and secondary haemorrhages were recorded. RESULTS: Seven studies contributed to the summative outcome. Coblation tonsillectomy appeared to result in less pain, less intra-operative blood loss (p < 0.01) and a shorter operative time (p < 0.01). There was no significant difference between the two groups for post-operative haemorrhage (p > 0.05). CONCLUSION: The coblation tonsillectomy technique may offer better peri-operative outcomes when compared to cold dissection, and should therefore be offered in paediatric cases, before cold dissection tonsillectomy.


Assuntos
Crioterapia/métodos , Dissecação/métodos , Eletrocoagulação/métodos , Tonsilectomia/métodos , Adolescente , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Duração da Cirurgia , Dor Pós-Operatória/etiologia
16.
Arq Bras Oftalmol ; 83(2): 87-91, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32159590

RESUMO

PURPOSE: The present study's aim was to compare the biomechanical properties of corneal tissue in patients who underwent deep anterior lamellar keratoplasty (DALK) surgery, with successful big bubble formation and manual lamellar dissection, during failed big bubble formation. METHODS: This retrospective comparative study included 60 eyes from 60 keratoconus patients who previously underwent DALK surgery. These patients were categorized as big bubble (+) or big bubble (-) based on the success or failure of big bubble formation during the surgery. The big bubble (+) group included 42 eyes, while the big bubble (-) group had 18 eyes. Moreover, the patients were regrouped as 0.25 mm and 0.50 mm to evaluate the effects of the disparity between donor and trephine punches on the biomechanical properties of the cornea. These biomechanical properties, characterized by corneal hysteresis and the corneal resistance factor, were measured using the Ocular Response Analyzer 12 months after the surgery. RESULTS: There was no statistically significant difference between the big bubble (+) and big bubble (-) groups in the biomechanical properties of the cornea (corneal hysteresis: 10.06, 10.25; p=0.716/corneal resistance factor: 10.15, 10.07; p=0.805, respectively). In addition, pachymetry results were not statistically different between the two groups. Multivariate regression analysis revealed that corneal hysteresis and corneal resistance factor were positively associated with central corneal thickness (p<0.001/r2=0.506; p<0.001/r2=0.561, respectively). However, the study did not demonstrate a relationship between any of the punch sizes and corneal hysteresis or between the punch sizes (p=0.673) and the corneal resistance factor (p=0.643). CONCLUSIONS: The corneal hysteresis and corneal resistance factor values were similar in big bubble and manual lamellar dissection after DALK. Thus, manual lamellar dissection was not a disadvantage considering the cornea's biomechanical properties.


Assuntos
Córnea/cirurgia , Transplante de Córnea/métodos , Ceratocone/cirurgia , Adulto , Fenômenos Biomecânicos , Córnea/fisiopatologia , Dissecação/métodos , Feminino , Humanos , Ceratocone/fisiopatologia , Masculino , Análise Multivariada , Valores de Referência , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
18.
Cir. Esp. (Ed. impr.) ; 98(2): 79-84, feb. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187966

RESUMO

Introducción: Ha habido un aumento en la implantación de reservorios subcutáneos en los últimos años. El objetivo de este estudio es comparar las técnicas de punción venosa (PV) frente a la disección venosa (DV). Métodos: Estudio de cohortes retrospectivo. Incluyó a pacientes que requirieron un Port-A-Cath*. Se dividió a los pacientes en 2grupos: PV y DV. Los pacientes eran mayores de 18 años, requerían tratamiento intravenoso continuado, sin restricciones de patología. Se excluyó a quienes habían sido portadores de un reservorio previo y pacientes pediátricos. La elección de la técnica se basó en preferencias del cirujano. Se analizaron los parámetros clínicos de edad, sexo, ASA, IMC, motivo de colocación y lateralidad, y los datos referidos a las complicaciones y la tasa de retirada en cada uno de los grupos. El seguimiento medio fue de 2 años. Resultados: Fueron incluidos 386 pacientes durante 5 años: 228 en el grupo DV y 155 en el grupo PV. En 3 casos la técnica no quedó registrada. No hubo diferencias entre ambos grupos en edad, sexo, ASA, IMC y motivo de implantación (p > 0,05). La DV presentó menor cifra de complicaciones y se observó un mayor recambio y retirada de catéter en PV. A pesar de ello, no hubo diferencias estadísticamente significativas (p = 0,113). Conclusiones: Tanto la DV como la PV son técnicas seguras y eficaces. En nuestra experiencia, la DV presentó mejores resultados intraoperatorios y a largo plazo. Se recomienda realizar más estudios para discernir la técnica a utilizar con mayor seguridad


Introduction: There has been an increase in the implantation of subcutaneous reservoirs in recent years. The objective of this study was to compare puncture techniques against venous dissection. Methods: This retrospective cohort study included patients who required a Port-a-Cath and were divided into two groups: venous puncture (PV) and venous dissection (DV). Patients were over 18 years of age, requiring continued intravenous treatment, with no restriction of pathology. Patients with a previous reservoir and < 18 years old were excluded. The choice of the technique was based on the surgeon's preferences. We analyzed the clinical parameters of age, sex, ASA, BMI, reason for placement and laterality, and data related to the complications and withdrawal rate in each of the groups. Results: 386 patients were included for 5 years: 228 DV group and 155 PV group. In three cases, the technique was not documented. There were no differences between the two groups with respect to age, sex, ASA, BMI and reason for implantation (p > 0.05). The average follow-up was two years. The DV group was found to have a lower number of complications, while the PV group had an increased incidence of catheter replacement and removal. However, these differences were not statistically significant (p = 0.113). Conclusions: Both DV and PV are safe and effective techniques. In our experience, DV presented better intraoperative and long-term results. Further studies are recommended to discern which technique to use more safely


Assuntos
Humanos , Dispositivos de Acesso Vascular , Técnicas de Diagnóstico por Cirurgia , Dissecação/métodos , Estudos de Coortes , Punções/métodos , Cateterismo Venoso Central , Estudos Retrospectivos , Eletrocardiografia , Radiografia Torácica , Complicações Intraoperatórias , Complicações Pós-Operatórias
19.
Am Surg ; 86(2): 146-151, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106908

RESUMO

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4-10 cm). D2: 4.9 ± 0.8 cm (3.5-7 cm). D3: 6.8 ± 0.9 cm (5-9 cm). D4: 6.1 ± 1 cm (4.8-8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.


Assuntos
Pontos de Referência Anatômicos/anatomia & histologia , Endoscopia/métodos , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Músculos Abdominais/anatomia & histologia , Dissecação/métodos , Artérias Epigástricas/anatomia & histologia , Humanos , Masculino , Estudos Prospectivos , Sínfise Pubiana/anatomia & histologia , Telas Cirúrgicas , Artérias Umbilicais/anatomia & histologia , Ducto Deferente/anatomia & histologia
20.
Ann Thorac Surg ; 109(6): 1692-1699, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32057812

RESUMO

BACKGROUND: The choice between electrocautery or automatic suturing instruments for dissection of the lung parenchyma along the intersegmental plane during lung segmentectomy remains controversial. We hypothesized that a novel microwave surgical instrument (MSI) for dissecting the lung parenchyma could have excellent sealing effects. We examined the feasibility and safety of lung parenchymal dissection using a MSI during lung segmentectomy. METHODS: This was a prospective clinical study of lung segmentectomy involving dissection of the entire intersegmental plane using a MSI. Complications related to sealing of the lung parenchyma were evaluated and perioperative outcomes were compared to those of patients who underwent lung segmentectomy using automatic suturing instruments. Propensity score-matched comparisons were used to assess the potential impact of selection bias. RESULTS: Lung segmentectomy using a MSI was successfully performed in 30 patients. According to the propensity score matching analysis, intraoperative blood loss, length of hospital stay, and postoperative complications of the microwave group were significantly lesser (P = .019, .003, and .008, respectively) compared to those of the control group (n = 66). Prolonged air leakage was not observed. There were two cases of subcutaneous emphysema after removal of the chest tube, but no other grade 2 or higher complications were observed. No mortality occurred within 30 or 90 days postoperatively. CONCLUSIONS: The use of a MSI for lung parenchymal dissection was associated with lower blood loss during surgical procedures, reduced air leakage after the operation, and fewer postoperative complications.


Assuntos
Pneumonectomia/instrumentação , Pneumonectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Dissecação/métodos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Pulmão/cirurgia , Masculino , Micro-Ondas/uso terapêutico , Pessoa de Meia-Idade , Tecido Parenquimatoso/cirurgia , Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Ablação por Radiofrequência , Técnicas de Sutura/instrumentação , Resultado do Tratamento
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