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2.
Int J Pharm Compd ; 23(5): 383-385, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31513536
3.
Rev. bras. cir. plást ; 34(3): 423-427, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047173

RESUMO

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.


Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.


Assuntos
Humanos , Masculino , Adulto , História do Século XXI , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Retalhos Cirúrgicos , Ferimentos e Lesões , Queimaduras , Queimaduras por Corrente Elétrica , Técnicas de Fechamento de Ferimentos , Antebraço , Traumatismos do Antebraço , Mãos , Traumatismos da Mão , Complicações Intraoperatórias , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/reabilitação , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/reabilitação , Retalhos Cirúrgicos/efeitos adversos , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/reabilitação , Queimaduras por Corrente Elétrica/cirurgia , Queimaduras por Corrente Elétrica/complicações , Técnicas e Procedimentos Diagnósticos , Técnicas de Fechamento de Ferimentos/reabilitação , Antebraço/cirurgia , Traumatismos do Antebraço/cirurgia , Traumatismos do Antebraço/complicações , Traumatismos do Antebraço/reabilitação , Mãos/cirurgia , Traumatismos da Mão/cirurgia
4.
Rev. bras. cir. plást ; 34(3): 405-409, jul.-sep. 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047164

RESUMO

Introdução: Este estudo se trata de um relato de caso que tem por objetivo alertar os cirurgiões para uma possível complicação em pós-operatório de cirurgias estéticas longas sob anestesia geral. A Síndrome de Boerhaave é uma doença grave que ameaça a vida do paciente e merece um diagnóstico precoce até 12hs e um tratamento adequado. Relato de caso: A paciente no pós-operatório de cirurgia plástica abdominal e mastopexia apresentou, após anestesia geral, crises de vômito e náuseas. Resultados: Paciente com 58 anos do sexo feminino submetida à dermolipectomia abdominal e mastopexia pela a técnica de pedículo inferior sob raquianestesia, onde após um período de quatro horas do término da cirurgia apresentou vários episódios de vômitos. Após 10 horas do ato cirúrgico apresentou queixa de algia ao deglutir, seguida de algia intensa generalizada, dispneia intensa, sudorese, palidez, PA 90x50mmhg. Com a piora do quadro a paciente foi encaminhada para a unidade de terapia intensiva onde foi entubada. Foram realizados exames laboratoriais, toracocentese e exames radiológicos. Atualmente, a paciente encontra-se com prótese esofágica. Conclusões: Fazendo a correlação com a bibliografia, no caso em tela sugere-se evitar cirurgias prolongadas, principalmente sob anestesia geral onde pode ocorrer a retenção de gás carbônico, que pode levar a crise emética no pós-operatório em pacientes com antecedentes de doença esofagiana e estar atentos aos sintomas, não descartando a possibilidade da ocorrência da Síndrome Boerhaave.


Introduction: The objective of this case report is to alert surgeons to a possible postoperative complication of long cosmetic surgery under general anesthesia. Boerhaave syndrome is a serious life-threatening disease that requires diagnosis within 12 hours and proper treatment. Case report: A 58-year-old female patient presented with vomiting and nausea after abdominoplasty and mastopexy under general anesthesia. Results: The patient underwent dermolipectomy and mastopexy using the inferior pedicle technique under spinal anesthesia. Four hours after the operation, she presented several episodes of vomiting. Ten hours after the operation, she reported painful swallowing followed by generalized severe pain and presented severe dyspnea, sweating, pallor, and a 90/50 mmHg blood pressure. As the condition worsened, the patient was referred to the intensive care unit where she was intubated and underwent laboratory tests, thoracentesis, and radiological examinations. The patient currently uses an esophageal prosthesis. Conclusions: The literature suggests avoiding prolonged surgery, especially under general anesthesia, because of the risk of carbon dioxide retention, which may lead to postoperative emetic crisis in patients with a history of esophageal disease. It also suggests paying attention to symptoms, not excluding the possibility of Boerhaave syndrome.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Cirurgia Plástica , Transtornos da Motilidade Esofágica , Esôfago , Abdominoplastia , Anestesia Geral , Ruptura Espontânea/complicações , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Transtornos da Motilidade Esofágica/cirurgia , Transtornos da Motilidade Esofágica/complicações , Esôfago/cirurgia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Anestesia Geral/métodos
5.
BMC Surg ; 19(1): 119, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455337

RESUMO

BACKGROUND: As it may be argued that many surgical interventions provide obvious patient benefits, formal, staged assessment of the efficacy and safety of surgical procedures has historically been and remains uncommon. The majority of innovative surgical procedures have therefore often been developed based on anatomical and pathophysiological principles in an attempt to better manage clinical problems. MAIN BODY: In this manuscript, we sought to review and contrast the models for pharmaceutical and surgical innovation in North America, including their stages of development and methods of evaluation, monitoring, and regulation. We also aimed to review the present structure of academic surgery, the role of methodological experts and funding in conducting surgical research, and the current system of regulation of innovative surgical procedures. Finally, we highlight the influence that evidence and surgical history, education, training, and culture have on elective and emergency surgical decision-making. The above discussion is used to support the argument that the model used for assessment of innovative pharmaceuticals cannot be applied to that for evaluating surgical innovations. It is also used to support our position that although the evaluation and monitoring of innovative surgical procedures requires a rigorous, fit-for-purpose, and formal system of assessment to protect patient safety and prevent unexpected adverse health outcomes, it will only succeed if it is supported and championed by surgical practice leaders and respects surgical history, education, training, and culture. CONCLUSION: We conclude the above debate by providing a recommended approach to the evaluation, monitoring, and regulation of surgical innovations, which we hope may be used as a guide for all stakeholders involved in interpreting and/or conducting future surgical research.


Assuntos
Tomada de Decisões , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios/métodos , Humanos
6.
Medicine (Baltimore) ; 98(35): e16990, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464948

RESUMO

RATIONALE: Giant thoracic chordoma is a highly unusual disease with no standard curative managements yet. The objective of this study is to report a very rare case of giant thoracic chordoma successfully operated by combination of thoracoscopic surgery together with posterior spinal surgery. The management of these unique cases has yet to be well-documented. PATIENT CONCERNS: A 64-year-old man presented with a 4-month history of continuous and progressive back pain. The patient, who had been diagnosed of sacral chordoma for 2 years, received surgical treatment of posterior sacral tumor resection and instrumentation. A lytic, expanding lesion of the T5 and T6 vertebral and paraspinal region with mild epidural spinal cord compression was identified. DIAGNOSIS: MRI of spine and PET/CT showed spinal cord compression secondary to the epidural component of the T5 and T6 mass, with increased metastatic marrow infiltration of the left T5 and T6 vertebral and paravertebral region, which presented as a solid tumor. Postoperative pathology confirmed the diagnosis of thoracic chordoma. INTERVENTIONS: The patient underwent 1-stage thoracoscopic release of vertebral and paravertebral tumors, posterior resection of T5-T6 vertebral and paravertebral tumors, T4-T7 spinal canal decompression, and T2-T9 pedicle screw fixation procedure via a posterior approach. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 3-month and 6-month follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS: Taken together, the lesion's clinical features, imaging results, and pathological characteristics are unique. Combined efforts of specialists from orthopedics, thoracic surgery, neurosurgery, and medical oncology led to the successful diagnosis and management of this patient. Giant thoracic chordoma, although rare, should be part of the differential diagnosis when the patient has a history of sacral chordoma and presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the giant thoracic chordoma when the tumor has caused neurological deficits. One-stage thoracoscopic release or resection of vertebral and paravertebral tumor is also a good choice for surgical treatment.


Assuntos
Cordoma/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Vértebras Torácicas/cirurgia , Cordoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos Ortopédicos/métodos , Neoplasias da Coluna Vertebral/patologia , Toracoscopia/métodos
7.
J Surg Oncol ; 120(5): 864-872, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31355450

RESUMO

In the era of advanced cancer genomics, our recognition of hereditary cancer mutations continues to increase. Two of these conditions, which carry an increased risk of female cancers including endometrial, ovarian, breast, are hereditary breast and ovarian cancer syndrome and Lynch syndrome. Risk-reducing surgery, such as mastectomy, salpingo-oophorectomy, and hysterectomy may decrease cancer risk for mutation carriers. Background, indications, techniques, and consequences of these surgical procedures are reviewed.


Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias do Endométrio/diagnóstico , Predisposição Genética para Doença , Síndromes Neoplásicas Hereditárias/diagnóstico , Neoplasias Ovarianas/diagnóstico , Procedimentos Cirúrgicos Operatórios/métodos , Neoplasias do Endométrio/epidemiologia , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Síndromes Neoplásicas Hereditárias/epidemiologia , Síndromes Neoplásicas Hereditárias/genética , Síndromes Neoplásicas Hereditárias/cirurgia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/cirurgia , Prevalência , Fatores de Risco
10.
Br J Anaesth ; 123(4): 430-438, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31255290

RESUMO

BACKGROUND: Vasopressor agents are used to prevent intraoperative hypotension and ensure adequate perfusion. Vasopressors are usually administered as intermittent boluses or manually adjusted infusions, but this practice requires considerable time and attention. We have developed a closed-loop vasopressor (CLV) controller to correct hypotension more efficiently. Here, we conducted a proof-of-concept study to assess the feasibility and performance of CLV control in surgical patients. METHODS: Twenty patients scheduled for elective surgical procedures were included in this study. The goal of the CLV system was to maintain MAP within 5 mm Hg of the target MAP by automatically adjusting the rate of a norepinephrine infusion using MAP values recorded continuously from an arterial catheter. The primary outcome was the percentage of time that patients were hypotensive, as defined by a MAP of 5 mm Hg below the chosen target. Secondary outcomes included the total dose of norepinephrine, percentage of time with hypertension (MAP>5 mm Hg of the chosen target), raw percentage "time in target" and Varvel performance criteria. RESULTS: The 20 subjects (median age: 64 years [52-71]; male (35%)) underwent elective surgery lasting 154 min [124-233]. CLV control maintained MAP within ±5 mm Hg of the target for 91.6% (85.6-93.3) of the intraoperative period. Subjects were hypotensive for 2.6% of the intraoperative period (range, 0-8.4%). Additional performance criteria for the controller included mean absolute performance error of 2.9 (0.8) and mean predictive error of 0.5 (1.0). No subjects experienced major complications. CONCLUSIONS: In this proof of concept study, CLV control minimised perioperative hypotension in subjects undergoing moderate- or high-risk surgery. Further studies to demonstrate efficacy are warranted. TRIAL REGISTRY NUMBER: NCT03515161 (ClinicalTrials.gov).


Assuntos
Infusões Intravenosas/instrumentação , Norepinefrina/administração & dosagem , Procedimentos Cirúrgicos Operatórios/métodos , Vasoconstritores/efeitos adversos , Idoso , Anestesia , Pressão Sanguínea/efeitos dos fármacos , Procedimentos Cirúrgicos Eletivos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Hipertensão/induzido quimicamente , Hipotensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Norepinefrina/uso terapêutico , Resultado do Tratamento , Vasoconstritores/uso terapêutico
12.
Value Health ; 22(6): 704-711, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31198188

RESUMO

BACKGROUND: Adequately preparing patients for medical interventions is an important component of quality healthcare. Nevertheless, few instruments for assessing patients' preparation exist. OBJECTIVES: To develop a psychometrically rigorous instrument to assess patients' perceptions of the quality of preparation. METHODS: An instrument to measure patients' preparation for medical interventions (MiPrep) was developed and tested with patients undergoing medical imaging, radiotherapy, or surgery. Patients were recruited and asked to complete 2 surveys. Survey A assessed patient and intervention characteristics. Survey B (postintervention) contained MiPrep to assess validity (face, content, and construct) and reliability (internal consistency and test-retest). RESULTS: A total of 869 (85%) patients consented to participate and 551 (63%) returned the postintervention survey. Face and content validity were demonstrated. Exploratory factor analysis identified 2 survey modules: receipt and adequacy of information (2 domains) and overall appraisal of patient-centered care (1 domain). Reliability was evidenced by adequate internal consistency (Cronbach α 0.81-0.89) and item-total correlations higher than 0.20. Nevertheless, individual item test-retest reliability requires further confirmation. The final instrument contained 27 items. CONCLUSIONS: The MiPrep instrument has evidence of being a valid and reliable instrument of preparation for medical interventions. Healthcare providers can use the instrument as a quality assurance tool to identify areas for improvement and areas of excellence in patients' preparation. Future studies should verify these findings in other populations and examine the divergent and predictive validity of the instrument.


Assuntos
Pacientes/psicologia , Percepção , Psicometria/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico por Imagem/métodos , Diagnóstico por Imagem/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Psicometria/métodos , Reprodutibilidade dos Testes , Autoeficácia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/psicologia
13.
Prensa méd. argent ; 105(4): 185-191, jun 2019. fig
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1026842

RESUMO

In the course of the study, histological preparations of 35 patients aged 16­25 years with incisor crowding who underwent orthodontic treatment with the fixed appliances according to the standard technique, had been analyzed. Three groups of patients had been distinguished: the first one was the reference group, the second one was the group of patients with the fiberotomy conducted before treatment with fixed orthodontic appliances, and the third one was the group of patients with the fiberotomy performed after the removal of fixed orthodontic appliances according to a standard technique used in the Department of Maxillofacial Surgery and Dentistry of Samara State Medical University (SamSMU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Procedimentos Cirúrgicos Operatórios/métodos , Estudos de Casos e Controles , Técnicas Histológicas , Processo Alveolar , /tendências , Má Oclusão/terapia
14.
Rev. bras. cir. plást ; 34(2): 287-290, apr.-jun. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1015993

RESUMO

A síndrome de Eagle é uma condição rara e com etiologia ainda não bem estabelecida, a qual se deve ter bastante suspeição para seu correto tratamento. Seu tratamento deve ser definido em conjunto com o paciente, seja ele conservador ou cirúrgico, sempre levando em consideração as expectativas do paciente, além da maior expertise do profissional na modalidade escolhida para o tratamento. Neste artigo, apresentamos uma paciente de 35 anos atendida no Hospital Felício Rocho, discutindo os diversos aspectos da doença, inclusive a modalidade de tratamento escolhida para o caso.


Eagle syndrome is a rare condition, and its etiology has not yet been well established and its correct treatment is uncertain. Its treatment must be defined together with the patient, be it conservative or surgical, always taking into consideration the patient's expectations, in addition to a solid professional expertise in the modality chosen for the treatment. In this article, we present the case of a 35-year-old patient who was admitted to the Felício Rocho Hospital and discuss the various aspects of the disease, including the treatment modality chosen for the case.


Assuntos
Humanos , Feminino , Adulto , Osso Petroso/cirurgia , Osso Petroso/lesões , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Dor Facial/cirurgia , Neuralgia Facial/cirurgia , Processo Mastoide/anatomia & histologia , Processo Mastoide/fisiopatologia
15.
Rev. bras. cir. plást ; 34(2): 299-305, apr.-jun. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1016004

RESUMO

Não é novidade para os cirurgiões plásticos, especialmente aos que se dedicam à cirurgia de face, que o nervo facial pode ser lesado virtualmente em qualquer cirurgia de ritidoplastia. Porém, apesar da importância contida nesse tema, não é tarefa simples encontrar na literatura artigos que abordem de forma objetiva a correlação entre lesão do nervo facial e cirurgia facial. Paralisias faciais, sejam elas completas ou não, podem se tornar situações potencialmente conflituosas na relação médicopaciente. Este artigo, portanto, visa propor de forma clara e sucinta, baseada na experiência dos autores, um guia de como evitar, identificar e tratar uma potencial lesão do nervo facial no contexto de uma cirurgia de face, em especial a ritidoplastia.


Is largely known that the facial nerve virtually can be injured in every facial lift. Even though its importance, it is difficult to find in the literature articles related to this theme. Complete or incomplete facial paralysis after a facial procedures, may become a very uncomfortable situation between the patient and the surgeon, that is why we propose in this article a guide which intends to help avoid, identify and manage a facial nerve injury in the event of a face lift. Identifying Facial palsy before the surgery: Intending to make the pre-op facial assessment as simple as possible, we suggest a systematic approach examination. Avoiding facial nerve injury during face lifting: Several technical details are discussed along the text aiming to minimize the risk of nerve damage during the surgical procedure. What to in the event of a post-operative facial palsy: The authors propose a logical approach to the facial palsy, suggesting a planning for diagnosis, classification of the lesion and a rational treatment for the injury. Conclusion: This article presents a guide showing some safe technical options to avoid nerve damage during rythidoplasty, how to identify the lesion and treat it if necessary.


Assuntos
Humanos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Ritidoplastia/efeitos adversos , Ritidoplastia/métodos , Guia de Prática Clínica , Face/cirurgia , Traumatismos Faciais/cirurgia , Traumatismos Faciais/complicações , Nervo Facial/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos
16.
Rev. bras. cir. plást ; 34(2): 204-209, apr.-jun. 2019. tab
Artigo em Inglês, Português | LILACS | ID: biblio-1015968

RESUMO

Introdução: Avaliar os resultados da mamoplastia redutora por meio do instrumento BREAST-Q®. Métodos: Foram selecionadas 83 pacientes portadoras de hipertrofia mamária atendidas no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal de Juiz de Fora (HU-UFJF), conduzidas em um estudo de coorte prospectivo. Com idade superior a 18 anos, alfabetizadas, operadas no período entre julho de 2013 a agosto de 2015. Utilizou-se o questionário BREAST-Q®, módulo para mamoplastia redutora/mastopexia no pré-operatório e com seis meses de pós-operatório. Teste t pareado foi utilizado para avaliar a significância das mudanças na satisfação com as mamas, bem-estar psicossocial, bem-estar físico e bemestar sexual. Resultados: Setenta e nove pacientes (95,1%) responderam os questionários de pré e pós-operatório. Melhoras com significância estatística foram observadas nas médias das categorias presentes quando comparados pré e pós-operatório, como satisfação com as mamas, bem-estar psicossocial, bemestar físico e bem-estar sexual. Idade, peso retirado e estado nutricional não influenciaram os resultados. As complicações foram observadas em dez (12,04%) pacientes. Conclusão: O BREAST-Q® mostrou que as pacientes com hipertrofia mamária submetidas à cirurgia para redução do volume mamário tiveram uma melhora significativa na qualidade de vida em seus diversos aspectos, além de avaliar como positivo o resultado cirúrgico, a atuação da equipe médico-hospitalar e a satisfação com os mamilos no pós-operatório tardio.


Introduction: To evaluate the results of breast reduction using the BREAST-Q® instrument. Methods: This is a prospective cohort study of 83 patients with breast hypertrophy who were treated at the Plastic Surgery Service of the University Hospital of the Federal University of Juiz de Fora. The subjects were older than 18, were literate, and underwent surgery between July 2013 and August 2015. We administered the BREAST-Q® reduction mammoplasty/mastopexy questionnaire, both during the preoperative period and at 6 months after surgery. The Student's t-test was used to evaluate the significance of changes in breast satisfaction and the psychosocial, physical, and sexual well-being of the patients. Results: Seventy-nine patients (95.1%) completed the pre- and postoperative questionnaires. Significant postoperative improvements were observed in breast satisfaction and the psychosocial, physical, and sexual wellbeing. Age, amount of breast tissue removed, and nutritional status did not influence the results. Surgical complications were observed in 10 patients (12.04%). Conclusion: The BREAST-Q® showed that patients who underwent breast reduction surgery achieved a significant improvement in quality of life and were satisfied with the surgical outcome, hospital care, and nipple appearance in the late postoperative period.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Seguridade Social/psicologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Mama/cirurgia , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Hipertrofia/complicações , Qualidade de Vida , Inquéritos e Questionários
17.
World J Emerg Surg ; 14: 22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31086560

RESUMO

Background: To prepare for surgery, surgeons often recur to surgical videos, with YouTube being reported as the preferred source. This study aimed to compare the evaluation of three surgical trainees and three senior surgeons of the 25 most viewed laparoscopic appendectomy videos listed on YouTube. Additionally, we assessed the video conformity to the published guidelines on how to report laparoscopic surgery videos (LAP-VEGaS). Methods: Based on the number of visualization, the 25 most viewed videos on laparoscopic appendectomy uploaded on YouTube between 2010 and 2018 were selected. Videos were evaluated on the surgical technical performance (GOALS score), critical view of safety (CVS), and overall video quality and utility. Results: Video image quality was poor for nine (36%) videos, good for nine (36%), and in high definition for seven (28%). Educational content (e.g., audio or written commentary) was rarely present. With the exception of the overall level of difficulty, poor consistency was observed for the GOALS domains between senior surgeons and trainees. Fifteen videos (60%) demonstrated a satisfactory CVS score (≥ 5). Concerning the overall video quality, agreement among senior surgeons was higher (Cronbach's alpha 0.897) than among trainees (Cronbach's alpha 0.731). The mean overall videos utility (Likert scale, 1 to 5) was 1.92 (SD 0.88) for senior examiners, and 3.24 (SD 1.02) for trainee examiners. The conformity to the LAP-VEGaS guidelines was weak, with a median value of 8.1% (range 5.4-18.9%). Conclusion: Laparoscopic videos represent a useful and appropriate educational tool but they are not sufficiently reviewed to obtained standard quality. A global effort should be made to improve the educational value of the uploaded surgical videos, starting from the application of the nowadays-available LAP-VEGaS guidelines.


Assuntos
Apendicectomia/métodos , Educação em Saúde/métodos , Mídias Sociais/normas , Educação em Saúde/normas , Humanos , Internet , Laparoscopia/métodos , Mídias Sociais/instrumentação , Procedimentos Cirúrgicos Operatórios/métodos , Gravação em Vídeo/métodos
18.
Am Surg ; 85(4): 420-430, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31043205

RESUMO

The aim of this study was to review and analyze all of the "concurrent surgery" (CS) and "overlapping surgery" (OS) literature with the goal of: standardizing terminology, defining discrepancies in the literature and proposing solutions for the current challenges of regulating surgery to achieve maximal safety and efficiency. The CS and OS literature has grown exponentially over the past two years. Before this, there were no significant publications addressing this topic. There is an extremely wide variance on how "running two rooms" is defined and whether it should be permitted. These differences affect our patients' perception of this practice. The literature lacks any comprehensive review of the topic and terminology. We performed a PubMed search to identify studies that considered the issue of OS. The terms "overlapping surgery", "concurrent surgery", and "simultaneous surgery" (SS) were used in the query. We then analyzed the publications identified. The literature contained 18 published studies analyzing OS safety between November 2016 and June 2018. Eight were neurosurgical studies, three were orthopedic, and the remaining seven articles were in other surgical specialties. A total of 1,207,155 surgical cases (range 250->500,000 patients) were analyzed among the 18 studies. There were 57,880 (5.04%) OS cases. The OS rates in the individual studies ranged from 1.2 to 68 per cent (Table 1). Neurosurgical studies had the highest average OS rate of 54 per cent (range 37-68%), whereas the average OS rate in orthopedic surgery was 43 per cent (range 2.7-68%). Approximately one-third of the studies were multicenter investigations (27.7%). The studies measured more than 20 distinct outcomes, but there were only five outcomes that were included in the majority of the studies: mortality rates, reoperation rates, procedure length of time, readmission rates, and hospital length of stay. The current body of literature repeatedly demonstrates that OS is a safe and effective option when undertaken by experienced surgeons who practice it frequently. For successful OS, the Mandatory Attending Portion for two surgeries must not overlap and Unnecessary Anesthesia Time must be prohibited. Hospitals and surgical specialty organizations must implement policies to assure the safe practice of OS.


Assuntos
Salas Cirúrgicas/organização & administração , Cirurgiões/organização & administração , Procedimentos Cirúrgicos Operatórios/métodos , Humanos
19.
Adv Otorhinolaryngol ; 83: 54-65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943502

RESUMO

There has been a general shift in the treatment of hypopharyngeal cancer from open surgical techniques (either radical or partial "organ" preserving) toward non-surgi cal "organ preserving" strategies (radiotherapy [RT] or chemoradiotherapy [CRT]) and minimally invasive transoral laser microsurgery (TLM) or transoral robotic surgery (TORS). Oncologic outcomes reported are comparable whatever modality is chosen, but better functional outcomes are observed in the RT/CRT and TLM/TORS-treated patients. Because of the high rate of second primary malignancies, which influences overall survival, one could favor an up-front transoral surgical procedure as a primary treatment modality for early hypoharyngeal carcinoma, leaving the (chemo)radiotherapeutic option open for treatment of a likely later emerging second primary. However, the TLM and TORS studies report a high rate of adjuvant irradiation-based treatment for close or positive margin excisions. Concerning post-treatment functionality, both RT/CRT and TLM/TORS yield satisfactory results, especially when compared to the open surgical procedures, but it remains unclear which of these options will result in the long-term best laryngopharyngeal functional outcome. There is a need for multi-institutional randomized controlled trials comparing the long term oncologic and functional outcomes of up-front minimal invasive transoral surgery with/without adjuvant treatment, to a primary non-surgical organ preservation treatment.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Hipofaríngeas/cirurgia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia , Humanos , Neoplasias Hipofaríngeas/terapia , Microcirurgia , Cirurgia Endoscópica por Orifício Natural , Estadiamento de Neoplasias , Radioterapia , Procedimentos Cirúrgicos Robóticos , Procedimentos Cirúrgicos Operatórios/métodos
20.
Adv Otorhinolaryngol ; 83: 66-75, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943506

RESUMO

It is not uncommon for patients with hypopharyngeal cancer to present at an advanced stage of disease. Surgical treatment provides a cure for the tumour with immediate relief from obstruction to the airway and the swallowing passage. Careful planning of surgery is important to ensure good outcome of treatment and prevent complications, some of which may be fatal. The shape of the hypopharynx resembles that of a funnel, with a wide circumference above in continuity with the oropharynx, and a small circumference below where it joins with the cervical oesophagus. As a result, while small tumours require the partial removal of the hypopharynx, large tumours, especially those involving the post-cricoid region, warrant a complete, circumferential pharyngectomy. For tumours that invade the cervical esophagus, transcervical approach is still feasible, and this is facilitated by the removal of the manubrium, allowing access to the tumour and resection with clear margins. In the presence of synchronous tumours lower down in the esophagus, pharyngo-laryngo-esophagectomy is indicated. Successful reconstruction of defects after tumour extirpation allows proper wound healing and early delivery of adjuvant radiotherapy. It is also important to ensure quick recovery of the long-term swallowing function. It ranges from the use of the soft tissue flap with skin island that is sutured as a patch to the remnants of the pharyngeal mucosa, to the use of a visceral flap, such as the free jejunal flap, to repair the circumferential pharyngectomy defects. The treatment protocol is personalized according to the extent of the tumour and the characteristics of the patients.


Assuntos
Neoplasias Hipofaríngeas/cirurgia , Hipofaringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Humanos , Neoplasias Hipofaríngeas/patologia , Neoplasias Hipofaríngeas/reabilitação , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Operatórios/métodos
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