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1.
Chemphyschem ; 21(2): 131, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-31957181

RESUMO

The front cover artwork is provided by the group of Dr. Baojun Wang (The University of Edinburgh). The image shows an engineered bacterial cell containing a genetic amplifier circuit which transforms a weak input signal into a larger easily detectable output signal. The electronics symbols used to illustrate the genetic circuit highlight the programmability of the circuit components enabled by state-of-the-art synthetic biology tools. Read the full text of the Review at 10.1002/cphc.201900739.


Assuntos
Bactérias/citologia , Engenharia Celular , Eletrônica , Ilustração Médica , Biologia Sintética , Humanos
2.
Int Braz J Urol ; 46(1): 108-115, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851467

RESUMO

OBJECTIVE: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. MATERIALS AND METHODS: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. RESULTS: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. CONCLUSION: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.


Assuntos
Colo Sigmoide/cirurgia , Colostomia/métodos , Derivação Urinária/métodos , Adulto , Anastomose Cirúrgica , Cistectomia/métodos , Humanos , Tempo de Internação , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Duração da Cirurgia , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças da Bexiga Urinária/cirurgia
3.
Int Braz J Urol ; 45(6): 1238-1248, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808413

RESUMO

INTRODUCTION: Pubic hypertrophy, defined as an abnormal and abundant round mass of fatty tissue located over the pubic symphysis, is frequently underestimated in patients with hypospadias. We examined the prevalence of this condition, as well as the outcomes associated with its surgical treatment. MATERIAL AND METHODS: Within 266 hypospadias patients treated at our clinic, we assessed the prevalence of pubic hypertrophy, and we schematically described the surgical steps of pubic lipectomy. Multivariable logistic regression (MLR) tested for predictors of pubic hypertrophy. Finally, separate MLRs tested for predictors of fistula and any complications after pubic lipectomy. RESULTS: Of 266 hypospadias patients, 100 (37.6%) presented pubic hypertrophy and underwent pubic lipectomy. Patients with pubic hypertrophy more frequently had proximal hypospadias (44 vs. 7.8%), disorders of sex development (DSD) (10 vs. 0.6%), cryptorchidism (12 vs. 2.4%), and moderate (30°-60°) or severe (>60°) penile curvature (33 vs. 4.2%). In MLR, the loca-tion of urethral meatus (proximal, Odds ratio [OR]: 10.1, p<0.001) was the only signifi cant pre-dictor of pubic hypertrophy. Finally, pubic lipectomy was not associated with increased risk of fi stula (OR: 1.12, p=0.7) or any complications (OR: 1.37, 95% CI: 0.64-2.88, p=0.4) after multi-variable adjustment. CONCLUSIONS: One out of three hypospadias patients, referred to our center, presented pubic hypertrophy and received pubic lipectomy. This rate was higher in patients with proximal hypospadias suggesting a correlation between pubic hypertrophy and severity of hypospadias. Noteworthy, pubic lipectomy was not associated with increased risk of fistula or any complications.


Assuntos
Hipospadia/epidemiologia , Hipospadia/cirurgia , Lipectomia/métodos , Adolescente , Adulto , Humanos , Hipertrofia/epidemiologia , Hipertrofia/cirurgia , Modelos Logísticos , Masculino , Ilustração Médica , Pênis/cirurgia , Complicações Pós-Operatórias , Prevalência , Osso Púbico/cirurgia , Estudos Retrospectivos , Fatores de Risco , Sérvia/epidemiologia , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
5.
Braz J Cardiovasc Surg ; 34(5): 618-623, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31719014

RESUMO

In aortic valve disease cases, prosthetic valves have been used for valve replacement, however, these prostheses have inherent problems, and their quality in some countries is lower comparing to new-generation models, causing shorter durability. Aortic valve neocuspidization (AVNeo) has emerged as an option, which can be applied to a wide spectrum of these diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. We developed a surgical technique combining Bentall and Ozaki procedures to treat patients with concomitant ascending aorta replacement and AVNeo and we describe it in this paper.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/normas , Desenho de Prótese/normas , Humanos , Ilustração Médica , Reprodutibilidade dos Testes
6.
World Neurosurg ; 131: 385-390, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658580

RESUMO

Traumatic brain injury (TBI) represents a major public health concern worldwide, with no significant change in its epidemiology over the last 30 years. After TBI, the primary injury induces irreversible brain damage, which is untreatable. The subsequent secondary injury plays a critical role in the clinical prognosis because without effective treatment it will provide additional tissue damage. The resulting scenario is the rise in intracranial pressure (ICP) with the development of progressive neurological deficits. Current optimal management is based on a progressive, target-driven approach combining both medical and surgical treatment strategies among which is decompressive hemicraniectomy. With the advent of technology, research in the glymphatic pathways, and advances in microscopic surgery, a novel surgical technique-the cisternostomy-has emerged that holds promise in managing rising ICP in TBI-affected patients. In this article we describe the rationale for cisternostomy, an emerging microneurosurgical approach for the management of moderate to severe TBI.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Estomia/métodos , Contraindicações de Procedimentos , Craniectomia Descompressiva/métodos , Drenagem/métodos , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/cirurgia , Ilustração Médica , Microcirurgia/métodos
7.
World Neurosurg ; 131: 391-398, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31658581

RESUMO

The anterior approach to lumbar spine fusion, termed anterior lumbar interbody fusion (ALIF), is becoming increasingly popular, with numerous recognized indications, well-defined advantages, and potential complications. From its first theoretical description in 1932 and the first operation published in 1933 to the more recently reported less invasive procedures, an anterior approach to the lumbar spine has many technical variations. Here we describe the evolution of the anterior approach to the lumbar spine, from a hugely invasive transperitoneal route to the current minimally invasive retroperitoneal approach. Many advantages have been advocated for the ALIF approach, and some issues about intraoperative and postoperative complications need to be evaluated in a more specific and homogeneous manner.


Assuntos
Vértebras Lombares/cirurgia , Doenças da Coluna Vertebral/cirurgia , Fusão Vertebral/métodos , História do Século XX , Humanos , Laparoscopia/história , Laparoscopia/métodos , Laparoscopia/tendências , Ilustração Médica , Doenças da Coluna Vertebral/história , Fusão Vertebral/história , Fusão Vertebral/tendências
8.
Heart Surg Forum ; 22(5): E390-E395, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31596718

RESUMO

BACKGROUND: The development of minimally invasive mitral valve surgery has created the motivation for using this approach in young patients with chronic rheumatic valve disease. We report our recent experience with patients undergoing minimally mitral valve surgery in this group of patients. METHODS: Between July 2014 and June 2018, 142 patients with rheumatic mitral valve dysfunction underwent minimally invasive surgery through a right thoracotomy approach at the University Medical Center of Ho Chi Minh City in Vietnam. Diagnosis was confirmed with transthoracic and transesophageal echocardiography (TTE and TEE). We analyzed the in-hospital and midterm follow-up outcomes of this group. RESULTS: The mean age was 42.6 ± 9.6 years. Sixty patients (42.3%) were male. Sixty-three patients were diagnosed with functional severe tricuspid regurgitation, 29 patients were identified with moderate tricuspid regurgitation, and tricuspid annulus was more than 21 mm/m²). Mitral valve repair was performed in 16 patients (11.3%), and 126 patients underwent mitral valve replacement. Mitral valve repair techniques included annuloplasty, leaflet peeling, and commissurotomy. Thirty-day mortality was 0.7%. Two patients had to be converted to conventional sternotomy, due to left atrial appendage laceration and mitral annular rupture. The overall survival rate was 98.6%. Freedom from reoperation was 97.1%. CONCLUSIONS: In patients with rheumatic valve disease, minimally invasive mitral surgery safely and effectively can be performed with few perioperative complications and good midterm results.


Assuntos
Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Insuficiência da Valva Tricúspide/cirurgia , Adulto , Conversão para Cirurgia Aberta/estatística & dados numéricos , Ecocardiografia Transesofagiana , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Ilustração Médica , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/diagnóstico por imagem , Valva Mitral/lesões , Cardiopatia Reumática/diagnóstico por imagem , Esternotomia , Taxa de Sobrevida , Toracotomia/métodos , Insuficiência da Valva Tricúspide/diagnóstico
9.
Neurology ; 93(14): 624-629, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31570637

RESUMO

On June 7, 1906, Jules Dejerine (1849-1917) and Gustave Roussy (1874-1948) presented to the Société de Neurologie de Paris the first description of the thalamic syndrome with serial-section microscopic images. They also provided the first account of central poststroke pain (CPSP). They suggested that pain is one of the primary symptoms of the syndrome, although one of their own patients ("Hud") did not have pain. Several contemporary studies have highlighted the involvement of the anterior part of the pulvinar (PuA) in patients with CPSP of thalamic origin. Two historical observations (cases Jos and Hud) are reviewed here using the Morel nuclei staining atlas (2007). Dejerine and Roussy proposed the "irritative theory" to explain CPSP of thalamic origin and, in line with the most recent literature, they invoked the involvement of the PuA. When matching images for the Jos and Hud cases with the Morel atlas, it appears that the lesions involved what Dejerine then termed the noyau externe; that is, the ventral posterolateral nucleus and the PuA. In the Jos case, the lesion extended medially to what Dejerine termed the noyau médian de Luys; that is, the central medial-parafascicular nuclei, whereas in the Hud case the lesion extended more inferiorly. From the finding in the Hud case, one can hypothesize that impairment of the PuA alone does not assure pain. The work of Dejerine and Roussy, based on clinico-anatomical correlations, remains relevant to this day.


Assuntos
Ilustração Médica/história , Doenças Talâmicas/história , Idoso , Feminino , História do Século XX , Humanos , Pessoa de Meia-Idade , Doenças Talâmicas/diagnóstico
10.
World Neurosurg ; 132: 377-388, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470165

RESUMO

For nearly 90 years, notions of the brain have been inextricably associated with a homunculus that has become embedded within medical education as the precise representation of rolandic cortical function. We sought to define the history, evolution, accuracy, and impact of this pictorial means of showing cortical representation. We mathematically defined the evolutionary accuracy of appropriate homunculi using image analysis techniques for all points defined by Penfield, Boldrey, Rasmussen, Jasper, and Erickson, calculating perpendicular distances and defining areas and distributions of rolandic and sylvian regions labeled for sensory and motor activity with comparison with all homunculi. Prerolandic sensory representation composed 13%-47% of total sensory area (mean, 29%); postrolandic motor representation composed 15%-65% of total motor area (mean, 31%). Discrepancy between cortical perpendicular length attributed to a particular function on 1937 diagrams was greater than that attributed on the 1950 homunculus (motor: mean, 74%; range, 63%-96%; sensory: mean, 66%; range, 17%-92%) (P < 0.05). The homunculus, if truly drawn according to cortical mapping evidence, could never have been recognized as near humanoid, yet it has attained epic educational and practical longevity.


Assuntos
Mapeamento Encefálico/história , Córtex Cerebral/anatomia & histologia , Ilustração Médica/história , Neurocirurgia/história , Canadá , Estimulação Elétrica , História do Século XX , Humanos
11.
Rev. Fund. Educ. Méd. (Ed. impr.) ; 22(4): 169-174, jul.-ago. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183077

RESUMO

Introducción: El aprendizaje de anatomía humana se ha realizado a lo largo de la historia, de forma teórica y práctica, a través de la disección cadavérica. Diversas teorías de aprendizaje señalan que el uso de claves de colores resulta esencial para mejorar el reconocimiento de estructuras complejas. Por este motivo, el objetivo de este artículo es presentar esta propuesta y describir algunas percepciones de los estudiantes de medicina de una universidad peruana ante esta estrategia. Sujetos y métodos: La estrategia se basa en el uso de diferentes colores para relacionar músculos con sus respectivas inserciones óseas y los nervios que los inervan. En el mismo sentido se hace uso del color para resaltar la dirección y relaciones de las arterias. En última instancia, se hace una relación de la misma clave de color con la función ejercida por determinado grupo muscular y la patología derivada del daño de dicha estructura. Para evaluar la aceptación del método y las percepciones que generó en los estudiantes, se aplicó una breve encuesta con motivos exploratorios en estudiantes de segundo a sexto año de medicina que hubieran usado estas ilustraciones. Resultados: Un 85,6% respondió que las ilustraciones 'son útiles como resumen gráfico de segmentos corporales', y un 84,9%, que 'pueden reproducirlas con facilidad y constituyen una ayuda nemotécnica en el estudio'. Conclusión: Se presenta un método sobre el uso de los colores como recurso para la relación de estructuras, función y patología en las ilustraciones de anatomía humana, el cual genera percepciones positivas en los estudiantes


Introduction: The learning of human anatomy has been carried out throughout history in a theoretical and practical way, through cadaveric dissection. Several learning theories point out that the use of color keys is essential to improve the recognition of complex structures, for this reason the objective of this article is to present this proposal, and to describe some perceptions of the medical students of a Peruvian university before this strategy. Subjects and methods: The strategy is based on the use of different colors to relate muscles with their respective bony inserts and the nerves that innervate them. In the same sense, color is used to highlight the direction and relationships of the arteries. Ultimately, a relation of the same color key is made with the function exerted by a certain muscle group and the pathology derived from the damage of said structure. To evaluate the acceptance of the method and the perceptions it generated in the students, we applied a brief survey with exploratory reasons in students from the second to the sixth year of medicine who have used these illustrations. Results: A 85.6% answered that 'they are useful as a graphic summary of body segments', and a 84.9%, that 'they can reproduce them easily, being a mnemonic aid in the study'. Conclusion: We present a method on the use of colors as a resource for the relationship of structures, function and pathology in human anatomy illustrations, which generates positive perceptions in students


Assuntos
Humanos , Masculino , Feminino , Adulto , Ilustração Médica/educação , Anatomia Artística/educação , Aprendizagem , Educação Médica , Materiais de Ensino , Percepção , Anatomia/educação , Plexo Braquial/anatomia & histologia , Estudantes de Medicina
12.
Zh Vopr Neirokhir Im N N Burdenko ; 83(3): 109-122, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31339504

RESUMO

PURPOSE: The study purpose is to explore the early history of head surgery in terms of artistic figures, based on authentic artistic artifacts of the past. MATERIAL AND METHODS: We performed a detailed analysis of many paintings, engravings, and illustrations for medical publications of the Middle Ages and Renaissance, which were definitely related to the early development of head surgery. RESULTS: The article summarizes a variety of illustrations that present the history of head surgery through images created by painters of the past, both recognized geniuses and those whose names have not been known to a non-specialist audience. Many artifacts are presented for the first time. CONCLUSION: We demonstrate that the art works reflect ideas of the past about life and death, causes of diseases, and their surgical treatment. At the same time, painters themselves, being an advanced part of the society, contributed to medicine, actively participating in the development of not only deontological norms but also people's attitudes to their health and to those who chose medicine as their profession. Their works enable modern doctors to imagine the first neurosurgeons of the past.


Assuntos
Ilustração Médica , Procedimentos Neurocirúrgicos , Pinturas
13.
World Neurosurg ; 131: 321-327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31284052

RESUMO

Deep-seated cerebral lesions have fascinated and frustrated countless surgical innovators since the dawn of the microneurosurgical era. To determine the optimal approach, the microneurosurgeon must take into account the characteristics and location of the pathological lesion as well as the operator's range of technical expertise. Increasingly, microneurosurgeons must select between multiple operative corridors that can provide access to the surgical target. Innovative trajectories have emerged for many indications that provide more flexible operative angles and superior exposure but result in longer working distances and more technically demanding maneuvers. In this article, we highlight 4 innovative surgical corridors and compare their strengths and weaknesses against those of more conventional approaches. Our goal is to use these examples to illustrate the following principles of microneurosurgical innovation: (1) discover more efficient and flexible exposures with superior working angles; (2) ensure maximal early protection of critical neurovascular structures; and (3) effectively handle target pathology with minimal disruption of normal tissues.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Craniotomia/métodos , Humanos , Ilustração Médica , Pinealoma/cirurgia , Neoplasias da Base do Crânio/cirurgia
14.
Acta Oncol ; 58(9): 1225-1237, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31155990

RESUMO

Background: Deformable image registration (DIR) is increasingly used in the field of radiation therapy (RT) to account for anatomical deformations. The aims of this paper are to describe the main applications of DIR in RT and discuss current DIR evaluation methods. Methods: Articles on DIR published from January 2000 to October 2018 were extracted from PubMed and Science Direct. Our search was restricted to articles that report data obtained from humans, were written in English, and address DIR methods for RT. A total of 207 articles were selected from among 2506 identified in the search process. Results: At planning, DIR is used for organ delineation using atlas-based segmentation, deformation-based planning target volume definition, functional planning and magnetic resonance imaging-based dose calculation. In image-guided RT, DIR is used for contour propagation and dose calculation on per-treatment imaging. DIR is also used to determine the accumulated dose from fraction to fraction in external beam RT and brachytherapy, both for dose reporting and adaptive RT. In the case of re-irradiation, DIR can be used to estimate the cumulated dose of the two irradiations. Finally, DIR can be used to predict toxicity in voxel-wise population analysis. However, the evaluation of DIR remains an open issue, especially when dealing with complex cases such as the disappearance of matter. To quantify DIR uncertainties, most evaluation methods are limited to geometry-based metrics. Software companies have now integrated DIR tools into treatment planning systems for clinical use, such as contour propagation and fraction dose accumulation. Conclusions: DIR is increasingly important in RT applications, from planning to toxicity prediction. DIR is routinely used to reduce the workload of contour propagation. However, its use for complex dosimetric applications must be carefully evaluated by combining quantitative and qualitative analyses.


Assuntos
Neoplasias/diagnóstico por imagem , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Braquiterapia , Humanos , Imagem por Ressonância Magnética , Ilustração Médica , Imagem Multimodal/métodos , Neoplasias/radioterapia , Dosagem Radioterapêutica , Reirradiação , Incerteza
16.
Rev Col Bras Cir ; 46(2): e2151, 2019 May 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31141032

RESUMO

Our objective is to describe the long biceps tendon transfer technique for the treatment of shoulder anterior instability. In this procedure, the long tendon of the biceps brachii is detached from the supraglenoid tubercle and transferred to the anterior edge of the glenoid cavity through a subscapularis tenotomy, reproducing the sling effect and increasing the anterior block. The technique is easy to perform and minimizes the risks of the coracoid process transfer. In conclusion, the transfer of the long tendon of the biceps brachii is an option for the treatment of glenohumeral instability.


Assuntos
Instabilidade Articular/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Transferência Tendinosa/métodos , Tendões/cirurgia , Tenotomia/métodos , Humanos , Ilustração Médica , Reprodutibilidade dos Testes , Resultado do Tratamento
19.
Lancet ; 393(10179): 1465-1472, 2019 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-30967217

RESUMO

Leonardo da Vinci (1452-1519) contributed to the study of the nervous system. His earliest surviving anatomical drawings (circa 1485-93) included studies of the skull, brain, and cerebral ventricles. These works reflected his efforts to understand medieval psychology, including the localisation of sensory and motor functions to the brain. He was also the first to pith a frog, concluding that piercing the spinal medulla causes immediate death. After a 10-year interval in the early 1500s Leonardo resumed his anatomical studies and developed a method to inject hot wax into the ventricular system, creating a cast that showed the shape and extent of the ventricles. During this period he also progressed in his understanding of the anatomy of the cranial nerves. Besides being the first to identify the olfactory nerve as a cranial nerve, his dissections showed him that contrary to previous theories, the nerves do not converge on the lateral or third ventricles. Leonardo also performed detailed studies of the peripheral nervous system. Although his discoveries had little influence on the development of the field of anatomy, they represent an astonishingly sharp break from the field that had seen little if any progress in the previous 13 centuries. His work reflects the emergence of the modern scientific era and forms a key part of his integrative approach to art and science.


Assuntos
Anatomia/história , Encéfalo/anatomia & histologia , Pessoas Famosas , Ilustração Médica/história , História do Século XV , História do Século XVI
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