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1.
Estima (Online) ; 18(1): e1020, jan.-dez. 2020.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1100027

RESUMO

Objetivo: Identificar na literatura as estratégias utilizadas pela equipe de enfermagem para prevenção de lesão por pressão em pacientes cirúrgicos. Métodos: Revisão integrativa, utilizando a estratégia PICo, tendo como questão norteadora: "quais as estratégias utilizadas pela equipe de enfermagem para prevenção de lesão por pressão em pacientes cirúrgicos?" As buscas foram realizadas nas bases de dados Web of Science, MEDLINE via PubMed, CINAHL, Cochrane, Scopus e no índice bibliográfico LILACS via BVS, sendo analisados 12 estudos. Resultados: O Brasil se destacou com quatro publicações e os estudos de coorte, com nível de evidência IV, prevaleceram em seis artigos. As intervenções tecnológicas para prevenção de lesão por pressão no centro cirúrgico foram colchões para distribuição de pressão, dispositivo para redução de pressão no calcâneo, instrumentos validados específicos para a classificação do risco de lesão por pressão em pacientes cirúrgicos, além de superfícies de apoio contendo polímero viscoelástico e outros utensílios para alívio da pressão decorrente do peso e de dispositivos médicos. Com relação às intervenções educativas, destacaram-se os protocolos, os treinamentos e a simulação realística. Conclusão: Observou-se que essas estratégias reduziram a incidência de lesão por pressão, além de diminuírem os custos e garantirem a satisfação dos pacientes.


Assuntos
Enfermagem , Lesão por Pressão , Posicionamento do Paciente , Período Perioperatório , Período Intraoperatório
2.
Ann Ital Chir ; 91: 235-238, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877383

RESUMO

The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.


Assuntos
Líquido Ascítico/virologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Perfuração Intestinal/cirurgia , Laparotomia , Pandemias , Pneumonia Viral/transmissão , Doenças do Colo Sigmoide/cirurgia , Viremia/transmissão , Aerossóis , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Divertículo/complicações , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/complicações , Perfuração Intestinal/virologia , Período Intraoperatório , Nasofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , RNA Viral/isolamento & purificação , Risco , Soro/virologia , Doenças do Colo Sigmoide/sangue , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/virologia , Viremia/virologia
3.
Plast Reconstr Surg ; 146(4): 847-858, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970007

RESUMO

BACKGROUND: No consensus exists about the safest position for performing the osseous genioplasty, with 5 to 6 mm below the mental foramen being the most frequently recommended position. This study intends to generate a safe distance guide to minimize the risk of inferior alveolar nerve injury during osteotomy. METHODS: Pretreatment cone-beam computed tomography-derived three-dimensional models from adult patients with skeletal class I to III patterns and cleft lip/palate deformity who underwent orthodontic-surgical interventions (n = 317) were analyzed. A three-dimensional vertical distance between the inferior margin of the mental foramen and the lowest point of the inferior alveolar nerve canal was measured in each three-dimensional hemimandible (n = 634). Statistical analysis was performed to generate the safe distance guide in a stepwise fashion at 95, 99, and 99.99 percent confidence levels. RESULTS: Class III (4.35 ± 1.42 mm) and cleft lip/palate (4.42 ± 1.53 mm) groups presented significantly (p < 0.001) larger three-dimensional distances than class I (3.44 ± 1.54 mm) and class II (3.66 ± 1.51 mm) groups. By considering the 5- to 6-mm safe distance parameter, 6.4, 5.0, 10.6, 16, and 9.9 percent of hemimandibles were at risk of osteotomy-induced nerve injury in the class I, class II, class III, cleft lip/palate, and overall cohorts, respectively. Overall, the safe distance zone to perform the osteotomy was set at 7.06, 8.01, and 9.12 mm below the mental foramen, with risk probabilities of 2.5, 0.5, and 0.0005 percent, respectively. CONCLUSION: This study contributes to patient safety and surgeon practice by proving a safe distance guide for genioplasty.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Tomografia Computadorizada de Feixe Cônico , Mentoplastia/métodos , Imageamento Tridimensional , Complicações Intraoperatórias/prevenção & controle , Traumatismos do Nervo Mandibular/prevenção & controle , Nervo Mandibular/diagnóstico por imagem , Cirurgia Assistida por Computador , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Humanos , Período Intraoperatório , Masculino , Estudos Retrospectivos , Adulto Jovem
4.
Medicine (Baltimore) ; 99(37): e22074, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925745

RESUMO

Hematological abnormalities at admission are common after traumatic brain injuries and are associated with poor outcomes. The objective of this study was to identify the predictive factors of mortality among patients who underwent emergency surgery for the evacuation of epidural hematoma (EDH) or subdural hematoma (SDH).This was a single-center retrospective cohort study of 200 patients who underwent emergency surgical evacuation of EDH or SDH between September 2010 and December 2018. Data on hematological parameters and clinical and intraoperative features were collected. The primary end-point was 1-year mortality after surgery. Univariate and multivariate analysis were performed, and the receiver operating characteristic (ROC) curves were assessed.Of the 200 patients included in this study, 102 (51%) patients died within 1 year of emergency surgery. Lymphocyte count at admission, creatinine levels, activated partial thromboplastin time (aPTT), age, intraoperative epinephrine use, and Glasgow Coma Scale (GCS) score were significantly associated with mortality in the multivariate analysis. The areas under the ROC curve for the GCS score, aPTT, and lymphocyte counts were 0.677 (95% confidence interval [CI] 0.602-0.753), 0.644 (95% CI 0.567-0.721), and 0.576 (95% CI 0.496-0.656), respectively.Patients with elevated lymphocyte counts on admission showed a higher rate of 1-year mortality following emergency craniectomy for EDH or SDH. In addition, prolonged aPTT and a lower GCS score were also related to poor survival.


Assuntos
Hematoma Epidural Craniano/sangue , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural Intracraniano/sangue , Hematoma Subdural Intracraniano/cirurgia , Adulto , Idoso , Biomarcadores/sangue , Craniotomia , Creatinina/sangue , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Feminino , Escala de Coma de Glasgow , Hematoma Epidural Craniano/mortalidade , Hematoma Subdural Intracraniano/mortalidade , Humanos , Período Intraoperatório , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Tempo de Tromboplastina Parcial , Prognóstico , Estudos Retrospectivos , Vasoconstritores/uso terapêutico
5.
PLoS One ; 15(6): e0234791, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555698

RESUMO

INTRODUCTION: Current methods of intraoperative margin assessment in breast conserving surgery are impractical, unreliable, or time consuming. We hypothesized that intraoperative near-infrared (NIR) imaging with an FDA-approved NIR optical contrast agent could identify canine mammary tumors, a spontaneous large animal model of human breast cancer, during surgery. METHODS: Dogs with mammary tumors underwent a standard of care lumpectomy or mastectomy with wide surgical margins 20 hours after indocyanine green administration (3 mg/kg IV). During surgery, NIR imaging was performed on tumors and wound margins in situ and tumors and lymph nodes ex vivo. Following resection, the wound bed was examined for residual fluorescence. Fluorescence intensity was determined by signal-to-background ratio (SBR). All tumors, areas of residual fluorescence, and lymph nodes underwent histopathologic analysis. RESULTS: There were 41 mammary tumors in 16 female dogs. Twenty tumors were malignant and 21 were benign. Twenty-eight tumors were fluorescent (mean SBR 1.5±0.2). Sensitivity of fluorescence for all malignant tumors was 80% (16/20) and 93.3% (14/15) for malignant tumors > 2 cm. Specificity for malignancy was low (< 2cm = 55%; > 2cm = 30%). Tumors > 2 cm were more likely to be fluorescent (OR 6.05, 95% CI 1.50-24.44, P = 0.011) but not more likely to be malignant (OR 3.09, 95% CI 0.86-11.14, P = 0.085) than tumors ≤ 2 cm. Four out of seven inguinal lymph nodes excised in the mastectomy specimen fluoresced. All four drained malignant tumors; however only 2/4 contained metastatic disease. CONCLUSION: Systemic ICG accumulates reliably in malignant canine mammary tumors > 2 cm. Although no tumor margins fluoresced, a wider margin of normal tissue is removed in canine mastectomy, making direct comparisons with breast conserving surgery difficult. Targeted NIR imaging agents are likely required to improve detection of smaller tumors and improve the specificity of NIR imaging for residual disease and metastatic lymph node detection.


Assuntos
Raios Infravermelhos , Neoplasias Mamárias Animais/diagnóstico por imagem , Neoplasias Mamárias Animais/cirurgia , Imagem Óptica , Animais , Modelos Animais de Doenças , Cães , Humanos , Período Intraoperatório , Metástase Linfática , Neoplasias Mamárias Animais/patologia
6.
PLoS One ; 15(6): e0234295, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32516319

RESUMO

AIM: The functional lumen imaging probe (FLIP) is a recently developed technique to evaluate the esophagogastric junction (EGJ) distensibility. Unlike timed barium esophagogram (TBE) and high-resolution manometry (HRM), FLIP can be used during peroral endoscopic myotomy (POEM). The aim of this study was to evaluate the association of intraoperative FLIP parameters with clinical outcomes as recorded in a single-center database and to investigate a systematic review of literatures. METHODS: We reviewed consecutive patients diagnosed with achalasia and scheduled for POEM between June 2016 and March 2019 in our tertiary referral hospital. All patients underwent intraoperative FLIP assessment during POEM. The final FLIP measurements were compared between the patients with good and poor clinical response. We comprehensively reviewed studies evaluating whether intraoperative FLIP measurements reflected clinical outcomes. RESULTS: We evaluated 23 patients with achalasia who underwent intraoperative FLIP before and after POEM. Two exhibited poor clinical responses after 3 months (Eckardt scores = 3). The final distensibility index (DI) did not differ significantly between good and poor responders (5.01 [4.52] vs. 4.91 [3.63-6.20] mm2/mmHg at a balloon distension of 50-mL, median [IQR], P = 0.853). The final DI did not differ significantly between post-POEM reflux esophagitis and non-reflux esophagitis groups (6.20 [5.15] vs. 4.23 [1.79] mm2/mmHg at a balloon distension of 50-mL, median [IQR], P = 0.075). CONCLUSIONS: A systematic review of both prospective and retrospective studies including our data indicated that the final intraoperative FLIP measurements did not differ significantly between good and poor responders. Further study with more patients is necessary to explore whether FLIP can predict short- and long-term clinical responses.


Assuntos
Acalasia Esofágica/diagnóstico por imagem , Acalasia Esofágica/cirurgia , Esofagoscopia , Miotomia/métodos , Humanos , Período Intraoperatório , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(21): e20291, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481310

RESUMO

Burr-hole craniostomy (BHC) is a widely accepted treatment for chronic subdural hematomas (CSDHs). This study adopted siphon irrigation to evacuate CSDHs and investigated its efficacy and safety as compared with the traditional irrigation used in BHC.A retrospective cohort study was conducted at a center between January 2017 and December 2018. The data of 171 patients who underwent burr-hole craniostomy for CSDH were collected and analyzed. A total of 68 patients underwent siphon irrigation (siphon group) and 103 patients were treated by a traditional method (control group). A follow-up was conducted 6 months after the surgery.No significant difference was observed in the baseline characteristics and preoperative computed tomography (CT) features of the 2 groups (P > .05). The postoperative CT features of the siphon group, which included the volume of hematoma evacuation (P = .034), hematoma evacuation rate (P < .001), recovery rate of the midline shift (P = .017), and occurrence of pneumocephalus (P = .037) were significantly different and better than those of the control group. The length of hospital stay after surgery of the siphon group was significantly shorter than that of the control group (P = .015). The Markwalder score of the siphon group was significantly superior to that of the control group on postoperative day 1 (P = .006). Although the recurrence rate in the siphon group (2/68, 2.5%) was lower than that in the control group (11/103, 8.9%), no statistically significant difference was observed between them (P = .069). Moreover, no significant differences were observed in terms of complications and mortality rate between the 2 groups.There was no significant difference in the recurrence rate between the groups that underwent siphon irrigation and traditional irrigation. However, in comparison, siphon irrigation can better improve postoperative CT features, promote early recovery of neurological dysfunction after surgery, and shorten the length of hospital stay. This indicates that siphon irrigation may be a better therapeutic option in BHC for CSDH.


Assuntos
Craniotomia/métodos , Hematoma Subdural Crônico/cirurgia , Trepanação/instrumentação , Idoso , Drenagem/métodos , Desenho de Equipamento , Feminino , Seguimentos , Hematoma Subdural Crônico/diagnóstico , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Irrigação Terapêutica/instrumentação , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Acta Cir Bras ; 35(4): e202000408, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32555939

RESUMO

PURPOSE: To evaluate the analgesic effect of esmolol in patients submitted to laparoscopic gastroplasty. METHODS: Forty patients aged between 18 and 50 years with American Society of Anesthesiologists (ASA) physical status scores of II and III who underwent gastric bypass were allocated to two groups. Group 1 patients received a 0.5-mg/kg bolus of esmolol in 30 mL of saline before induction of anesthesia, followed by an infusion at 15 µg/kg/min until the end of surgery. Group 2 patients received 30 mL of saline as a bolus and then an infusion of saline. Anesthesia included fentanyl (3 µg/kg), propofol (2-4 mg/kg), rocuronium (0.6 mg/kg), and 2% sevoflurane, with remifentanil if necessary. The following parameters were evaluated: pain intensity over 24h, remifentanil consumption, the first analgesic request, morphine consumption, and side effects. RESULTS: Pain intensity was lower in the esmolol group except at T0 (after extubation) and 12h postoperatively. Remifentanil supplementation, recovery time, and postoperative morphine supplementation were lower in the esmolol group. No differences in the time to the first analgesic request or side effects were found between the groups. CONCLUSION: Intraoperative esmolol promotes reductions in pain intensity and the need for analgesic supplementation without adverse effects, thus representing an effective drug for multimodal analgesia in gastroplasty.


Assuntos
Antagonistas de Receptores Adrenérgicos beta 1/uso terapêutico , Gastroplastia/efeitos adversos , Laparoscopia/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Propanolaminas/uso terapêutico , Adolescente , Adulto , Analgesia/métodos , Anestesia/métodos , Anestésicos/uso terapêutico , Método Duplo-Cego , Feminino , Gastroplastia/métodos , Humanos , Período Intraoperatório , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Náusea e Vômito Pós-Operatórios/prevenção & controle , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
9.
Middle East Afr J Ophthalmol ; 27(1): 47-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32549724

RESUMO

PURPOSE: The purpose of this study was to compare the efficacy and safety of cataract surgery by the phacoemulsification technique with and without the use of ophthalmic viscosurgical devices (OVDs). SETTING: This study was conducted at a tertiary eye care center in a rural area of Central India. DESIGN: This was a prospective, randomized, observational study. METHODS: In this study, 220 patients underwent phacoemulsification for cataract surgery with OVDs (OVD group) or without OVDs (BSS group) (n = 110 in each group). Patients with operable, nuclear Grade 2-4 cataracts were included in the study. The study was conducted from June 2017 to September 2018. The frequency of intraoperative complications, surgical time, and ease of the surgical procedure (easy, difficult, or very difficult) were recorded. RESULTS: There was no statistically significant difference in the nuclear opalescence, axial length, and intraocular lens (IOL) power between the two groups. Capsulorhexis extension was seen in two eyes in the OVD group and none of the eyes in the BSS group. The problems that occurred during IOL implantation included flip (OVD group, 2; BSS group, 1), haptic breakage (OVD group, 1; BSS group, 1), sulcus implantation (OVD group, 0; BSS group, 2), and stuck haptic (OVD group, 1; BSS group, 3). The total surgical time was almost equal in the two groups (OVD group, 9.2 min ± 3; BSS group, 9.5 min ± 3.5; P = 0.521). None of the patients had iris trauma or posterior capsular rupture. CONCLUSIONS: OVD-less phacoemulsification surgery is a safe and effective technique for treating age-related cataracts that requires no additional instrumentation and saves the cost of the OVD.


Assuntos
Complicações Intraoperatórias/diagnóstico , Implante de Lente Intraocular , Facoemulsificação/métodos , Viscossuplementos/administração & dosagem , Idoso , Capsulorrexe/métodos , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Pseudofacia/fisiopatologia , Acuidade Visual/fisiologia
10.
Rev Col Bras Cir ; 47: e20202558, 2020 Jun 03.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32578821

RESUMO

The coronavirus infection, also known as SARS-COV2, has proven to be potentially fatal, representing a major global health problem. Its spread after its origin in the city of Wuhan, China has resulted in a pandemic with the collapse of the health system in several countries, some with enormous social impact and expressive number of deaths as seen in Italy and Spain. Extreme intra and extra-hospital measures have been implemented to decrease the transmission and dissemination of the COVID-19. Regarding the surgical practice, a huge number of procedures considered non-essential or elective were cancelled and postponed until the pandemic is resolved. However, urgent and oncological procedures have been carried out. In this publication, we highlight and teach adaptations to be made with commonly used materials in laparoscopy to help prevent the spread and contamination of the healthcare team assisting surgical patients.


Assuntos
Aerossóis/efeitos adversos , Infecções por Coronavirus/prevenção & controle , Laparoscopia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Operatórios/normas , Betacoronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Período Intraoperatório , Salas Cirúrgicas/métodos , Pneumoperitônio Artificial/normas , Equipamentos de Proteção/normas , Punções/métodos , Instrumentos Cirúrgicos/normas
11.
Rev. cir. (Impr.) ; 72(3): 257-261, jun. 2020. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1115552

RESUMO

Resumen El cáncer gástrico es una patología de alta incidencia en Chile. Afortunadamente es baja la incidencia de márgenes R1 cuando se realiza una cirugía con intención curativa. Al tener un tumor subcardial o cardial es perentorio realizar una biopsia rápida (intraoperatoria), en caso que ésta resulte positiva, es difícil tomar una decisión sobre qué realizar a continuación, ya que el realizar una esofagoyeyunoanastomosis intratorácica aumenta el riesgo quirúrgico. Para esto, es de suma importancia tener la información de las características histopatológicas del tumor, el riesgo de filtración, la recurrencia, la sobrevida, las terapias adyuvantes y la realidad país. Se realizó una revisión de la literatura con el fin de poder guiar la toma de decisiones.


Gastric cancer is a pathology with a high incidence in Chile, fortunately, the incidence of R1 margins is low when performing surgery with curative intent. When having a sub cardial or cardial tumor, it is essential to perform a rapid (intraoperative) biopsy, if this is positive when cutting the esophagus just under the pillars, it is difficult to make the decision of what to do next, since performing an inthrathoracic esophagojejunostomy increases the surgical risk. For this, it is very important to have information about the histopathological characteristics of the tumor, the leakage risk, there currence, the survival, the adjuvant therapies and the reality of the country. A review of the literature was done in order to guide the decisions.


Assuntos
Humanos , Neoplasias Gástricas/cirurgia , Biópsia/métodos , Margens de Excisão , Recidiva , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Gastrectomia/métodos , Período Intraoperatório
13.
J Surg Oncol ; 122(2): 226-233, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32436255

RESUMO

BACKGROUND AND OBJECTIVES: Recently, PINPOINT, a novel laparoscopic fusion indocyanine green fluorescence imaging (IGFI) system has become available for laparoscopic liver resection. This study aims to characterize fluorescence patterns of intrahepatic cholangiocarcinoma (ICC) using the negative counterstaining method in laparoscopic anatomical hepatectomies of ICC. METHODS: Eleven consecutive patients, diagnosed with intrahepatic cholangiocarcinoma and underwent laparoscopic liver resection between April 2017 and December 2018, were retrospectively reviewed. A laparoscopic IGFI navigation system was used to characterize fluorescence patterns of ICC with intraoperative liver segment demarcation by means of negative counterstaining. RESULTS: Fusion IGFI of ICC was successfully obtained from all 11 patients from the surgical specimens. The fluorescence patterns of ICC can be categorized into rim-type fluorescence and segmental fluorescence, depending on tumor growth. In eight patients, indocyanine green fluorescence imaging was used to identify the hepatic lobes or segments by negative counterstaining. In six cases, a valid and persistent demarcation was achieved intraoperatively. CONCLUSION: Laparoscopic IGFI system could identify different types of ICC lesions and may facilitate real-time navigation for laparoscopic anatomic liver resection of ICC.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/cirurgia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/cirurgia , Verde de Indocianina/administração & dosagem , Imagem Óptica/métodos , Idoso , Idoso de 80 Anos ou mais , Corantes/administração & dosagem , Estudos de Viabilidade , Feminino , Humanos , Período Intraoperatório , Laparoscopia , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Coloração e Rotulagem/métodos
14.
Chirurg ; 91(9): 743-754, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32350557

RESUMO

BACKGROUND: Intraoperative radiotherapy (IORT) enables a high precision through surgical exposure of the tumor and the tumor bed, which leads to a maximum radiation dose to the tumor while simultaneously protecting normal tissue from radiation as the dose-limiting factor. Therefore, IORT can be particularly advantageous if local tumor control decisively impacts on long-term survival and enables functional preservation. OBJECTIVE: This review summarizes the knowledge gained from a literature search to enable an evidence-based approach with respect to indications and treatment options of IORT for intra-abdominal tumors. RESULTS AND CONCLUSION: Although the effectiveness of IORT cannot be finally assessed due to limited evidence, IORT is established in the clinical practice as a supplement to the multimodal treatment of (recurrent) rectal cancer and sarcomas. Gastric and pancreatic carcinomas are further indications but additional studies are necessary to clearly define the role of IORT in these tumor entities. An important factor to achieve a benefit with IORT seems to be patient selection in order to obtain good local control of local recurrences as well as overall survival rates for patients with primary or recurrent cancer.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Terapia Combinada , Humanos , Cuidados Intraoperatórios , Período Intraoperatório , Recidiva Local de Neoplasia , Neoplasias Pancreáticas , Neoplasias Retais
15.
Acta Cytol ; 64(5): 492-497, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32450564

RESUMO

INTRODUCTION: Since the late 1970s, sentinel lymph node biopsy (SLNB) has been used for several solid malignancies to identify lymph node metastases. This procedure is associated with less surgical morbidity than complete lymphadenectomy. Recent evidence suggests that axillary lymphadenectomy is not required for breast sentinel nodes with micrometastases (≤2 mm). Current clinical management of sentinel nodes indicates that only macrometastases (>2 mm) should be detected intraoperatively. In Japan, an intraoperative histopathological frozen section (FS) method is used to identify lymph node metastases, but this method takes more than 30 min and requires complex techniques and expensive equipment. Touch imprint cytology (TIC) is an easier, less expensive, and faster method, but its sensitivity has been shown to be low. OBJECTIVE: The purpose of this study was to determine if TIC is more useful than FS in identifying macrometastases in sentinel lymph nodes in preoperative node-negative breast cancer operations. METHODS: A prospective review of 49 consecutive patients with node-negative breast cancer treated with SLNB and intraoperative TIC and FS between November 2017 and June 2019 was performed. TIC samples were stained using Papanicolaou and Diff-Quick stains. Results were compared with routine postoperative paraffin sections. RESULTS: With TIC, the Papanicolaou stain took a mean of 12 min, and the Diff-Quick stain took a mean of 10 min. Results of both TIC stain methods were the same. In contrast, the FS method took a mean of 80 min (including the transfer of specimens to a different hospital with the necessary equipment). TIC confirmed macrometastases in 5 cases. All macrometastases were diagnosed equally by the 2 techniques. Both the sensitivity and specificity of TIC were 100% for detection of macrometastases. CONCLUSION: TIC of SLNB for breast cancer is an easy and useful method for the detection of macrometastases of breast sentinel nodes.


Assuntos
Neoplasias da Mama/patologia , Citodiagnóstico/métodos , Secções Congeladas/métodos , Biópsia de Linfonodo Sentinela , Linfonodo Sentinela/patologia , Axila , Neoplasias da Mama/cirurgia , Feminino , Humanos , Período Intraoperatório , Estudos Prospectivos , Linfonodo Sentinela/cirurgia
16.
Lancet Gastroenterol Hepatol ; 5(8): 753-764, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32416764

RESUMO

BACKGROUND: Complete surgical resection remains the primary curative option for pancreatic ductal adenocarcinoma, with positive margins in 30-70% of patients. In this study, we aimed to evaluate the use of intraoperative tumour-specific imaging to enhance a surgeon's ability to detect visually occult cancer in real time. METHODS: In this single-centre, open-label, single-arm study, done in the USA, we enrolled patients who had clinically suspicious or biopsy-confirmed pancreatic ductal adenocarcinomas and were scheduled for curative surgery. Eligible patients were 19 years of age or older with a life expectancy of more than 12 weeks and a Karnofsky performance status of at least 70% or an Eastern Cooperative Oncology Group or Zubrod level of one or lower, who were scheduled to undergo curative surgery. Patients were sequentially enrolled into each dosing group and 2-5 days before surgery, patients were intravenously infused with 100 mg of unlabelled panitumumab followed by 25 mg, 50 mg, or 75 mg of the near-infrared fluorescently labelled antibody (panitumumab-IRDye800CW). The primary endpoint was to determine the optimal dose of panitumumab-IRDye800CW in identifying pancreatic ductal adenocarcinomas as measured by tumour-to-background ratio in all patients. The tumour-to-background ratio was defined as the fluorescence signal of the tumour divided by the fluorescence signal of the surrounding healthy tissue. The dose-finding part of this study has been completed. This study is registered with ClinicalTrials.gov, NCT03384238. FINDINGS: Between April, 2018, and July, 2019, 16 patients were screened for enrolment onto the study. Of the 16 screened patients, two (12%) patients withdrew from the study and three (19%) were not eligible; 11 (69%) patients completed the trial, all of whom were clinically diagnosed with pancreatic ductal adenocarcinoma. The mean tumour-to-background ratio of primary tumours was 3·0 (SD 0·5) in the 25 mg group, 4·0 (SD 0·6) in the 50 mg group, and 3·7 (SD 0·4) in the 75 mg group; the optimal dose was identified as 50 mg. Intraoperatively, near-infrared fluorescence imaging provided enhanced visualisation of the primary tumours, metastatic lymph nodes, and small (<2 mm) peritoneal metastasis. Intravenous administration of panitumumab-IRDye800CW at the doses of 25 mg, 50 mg, and 75 mg did not result in any grade 3 or higher adverse events. There were no serious adverse events attributed to panitumumab-IRDye800CW, although four possibly related adverse events (grade 1 and 2) were reported in four patients. INTERPRETATION: To our knowledge, this study presents the first clinical use of panitumumab-IRDye800CW for detecting pancreatic ductal adenocarcinomas and shows that panitumumab-IRDye800CW is safe and feasible to use during pancreatic cancer surgery. Tumour-specific intraoperative imaging might have added value for treatment of patients with pancreatic ductal adenocarcinomas through improved patient selection and enhanced visualisation of surgical margins, metastatic lymph nodes, and distant metastasis. FUNDING: National Institutes of Health and the Netherlands Organization for Scientific Research.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Benzenossulfonatos/administração & dosagem , Carcinoma Ductal Pancreático/cirurgia , Indóis/administração & dosagem , Imagem Óptica/métodos , Neoplasias Pancreáticas/patologia , Panitumumabe/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Ductal Pancreático/diagnóstico por imagem , Carcinoma Ductal Pancreático/tratamento farmacológico , Feminino , Humanos , Infusões Intravenosas/métodos , Período Intraoperatório , Metástase Linfática/diagnóstico por imagem , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Países Baixos/epidemiologia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/secundário
17.
Medicine (Baltimore) ; 99(19): e20058, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384471

RESUMO

RATIONALE: A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years. PATIENT CONCERNS: A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago. DIAGNOSIS: A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE. INTERVENTIONS: The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded. OUTCOMES: After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications. LESSONS: TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.


Assuntos
Cateteres Cardíacos , Ecocardiografia Transesofagiana , Corpos Estranhos/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Idoso , Feminino , Humanos , Achados Incidentais , Período Intraoperatório
18.
Curr Opin Ophthalmol ; 31(4): 234-240, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32452876

RESUMO

PURPOSE OF REVIEW: To review current and emerging methods and utilities of preoperative, intraoperative, and postoperative measurements of corneal biomechanics and their effects on refractive surgery decision-making. RECENT FINDINGS: Several recent clinical and preclinical studies have demonstrated the utility of corneal biomechanical analysis in refractive surgery. These studies focus on both screening surgical candidates for keratoconic disease as well as intraoperative and postoperative monitoring. The measurement of spatially resolved biomechanics is beginning to be studied in humans. SUMMARY: Clinically available screening methods combining corneal biomechanics with topographic and tomographic data provide increased utility when screening for keratoconic disorder. Spatially resolved measurement of corneal biomechanics holds great potential for preoperative, intraoperative, and postoperative evaluation of refractive surgery candidates as well as for more individualized procedures in the future.


Assuntos
Córnea/fisiologia , Elasticidade/fisiologia , Procedimentos Cirúrgicos Refrativos , Fenômenos Biomecânicos , Córnea/cirurgia , Topografia da Córnea , Técnicas de Imagem por Elasticidade , Humanos , Período Intraoperatório , Período Pós-Operatório , Período Pré-Operatório
19.
Med. intensiva (Madr., Ed. impr.) ; 44(3): 185-191, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-190564

RESUMO

La cirugía torácica ha experimentado importantes avances en los últimos años relacionados con las técnicas anestésicas y quirúrgicas y la prevención y el manejo de las complicaciones relacionadas con el procedimiento. Esto ha permitido mejorar los resultados clínicos de los pacientes sometidos a este tipo de intervención. A pesar de ello, los procedimientos de cirugía torácica, especialmente los relacionados con la resección pulmonar, no están exentos de riesgo, con una morbimortalidad asociada considerable. Los protocolos Fast track o Enhanced recovery after anesthesia, la cirugía mínimamente invasiva y el manejo anestésico intraoperatorio mejoran el pronóstico y la seguridad de los procesos de cirugía torácica. Los pacientes postoperados de cirugía torácica mayor requieren una vigilancia intensiva, especialmente las primeras 24-72 h del postoperatorio inmediato. El ingreso en la UCI se recomienda especialmente en los pacientes con comorbilidad, con reserva cardiopulmonar reducida, con resecciones pulmonares extensas y en los que requieren soporte por fallo de algún órgano con riesgo vital. Durante el periodo postoperatorio la monitorización intensiva cardiorrespiratoria, el manejo adecuado de los drenajes torácicos, el control agresivo del dolor (analgesia multimodal y técnicas anestésicas regionales), las náuseas y la rehabilitación multimodal son elementos claves para evitar eventos adversos. Entre las complicaciones médicas destacan la insuficiencia respiratoria, las arritmias, las infecciones respiratorias, las atelectasias y la enfermedad pulmonar tromboembólica. Las complicaciones quirúrgicas más frecuentes son el hemotórax, el quilotórax, la fístula broncopleural y la fuga aérea prolongada. El manejo multidisciplinar de estos pacientes durante todo el periodo perioperatorio es esencial para asegurar los mejores resultados quirúrgicos


Thoracic surgery has undergone significant advances in recent years related to anesthetic and surgical techniques and the prevention and management of complications related to the procedure. This has allowed improvements in patient clinical outcomes in surgeries of this kind. Despite the above, thoracic surgery, especially related to pulmonary resection, is not without risk, and is associated to considerable morbidity and mortality. Fast track or enhanced recovery after anesthesia protocols, minimally invasive surgery, and intraoperative anesthetic management improve the prognosis and safety of thoracic surgery. Patients in the postoperative period of major thoracic surgery require intensive surveillance, especially the first 24-72 hours after surgery. Admission to the ICU is especially recommended in those patients with comorbidities, a reduced cardiopulmonary reserve, extensive lung resections, and those requiring support due to life-threatening organ failure. During the postoperative period, intensive cardiorespiratory monitoring, proper management of thoracic drainage, aggressive pain control (multimodal analgesia and regional anesthetic techniques), nausea and multimodal rehabilitation are key elements for avoiding adverse events. Medical complications include respiratory failure, arrhythmias, respiratory infections, atelectasis and thromboembolic lung disease. The most frequent surgical complications are hemothorax, chylothorax, bronchopleural fistula and prolonged air leakage. The multidisciplinary management of these patients throughout the perioperative period is essential in order to ensure the best surgical outcomes


Assuntos
Humanos , Pessoa de Meia-Idade , Cirurgia Torácica/métodos , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Operatórios , Período Perioperatório , Período Intraoperatório , Comunicação Interdisciplinar , Sociedades Médicas/normas , Antibioticoprofilaxia , Unidades de Terapia Intensiva/normas , Cuidados Pós-Operatórios
20.
Clinics (Sao Paulo) ; 75: e1639, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32321115

RESUMO

OBJECTIVES: The enhanced recovery after surgery (ERAS) protocol recommends prevention of intraoperative hypothermia. However, the beneficial effect of maintaining normothermia after radical cystectomy has not been evaluated. This study aimed to investigate the efficacy of fluid warming nursing in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy. METHODS: A total of 108 patients with bladder cancer scheduled to undergo DaVinci robotic-assisted laparoscopic radical cystectomy were recruited and randomly divided into the control group (n=55), which received a warming blanket (43°C) during the intraoperative period and the warming group (n=53), in which all intraoperative fluids were administered via a fluid warmer (41°C). The surgical data, body temperature, coagulation function indexes, and postoperative complications were compared between the two groups. RESULTS: Compared to the control group, the warming group had significantly less intraoperative transfusion (p=0.028) and shorter hospitalization days (p<0.05). During the entire intraoperative period (from 1 to 6h), body temperature was significantly higher in the warming group than in the control group. There were significant differences in preoperative fibrinogen level, white blood cell count, total bilirubin level, intraoperative lactose level, postoperative thrombin time (TT), and platelet count between the control and warming groups. Multivariate linear regression analysis demonstrated that TT was the only significant factor, suggesting that the warming group had a lower TT than the control group. CONCLUSION: Fluid warming nursing can effectively reduce transfusion requirement and hospitalization days, maintain intraoperative normothermia, and promote postoperative coagulation function in elderly patients undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy.


Assuntos
Temperatura Corporal/fisiologia , Cistectomia/métodos , Cuidados Intraoperatórios/métodos , Complicações Intraoperatórias/prevenção & controle , Laparoscopia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias da Bexiga Urinária/cirurgia , Idoso , Feminino , Humanos , Período Intraoperatório , Masculino , Complicações Pós-Operatórias/prevenção & controle , Tremor por Sensação de Frio/fisiologia , Neoplasias da Bexiga Urinária/patologia
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