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Medicine (Baltimore) ; 99(27): e21111, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629744


RATIONALE: Intermittent combined pancreaticobiliary obstruction may lead to multiple episodes of ascending cholangitis and pancreatitis, usually due to choledocholithiasis or periampullary mass. However, one of the rare causes is periampullary or juxtapapillary duodenal diverticulum. Although duodenal diverticula are relatively common in the general population, the overwhelming majority are asymptomatic. Duodenal diverticula can cause combined pancreaticobiliary obstruction through multiple mechanisms such as stasis-induced primary choledocholithiasis, stasis-induced intradiverticular enterolith, or longstanding diverticulitis, causing stenosing fibrosing papillitis or a combination of more than one of these mechanisms. Herein, I report a case of Lemmel syndrome due to a combination of multiple mechanisms and review the available literature on the epidemiology, pathogenesis, clinical presentation, diagnostic work-up, and management of juxtapapillary duodenal diverticulum. PATIENT CONCERNS: Multiple episodes of abdominal pain, jaundice, anorexia, fever, and significant unintentional weight loss. DIAGNOSES AND INTERVENTIONS: Primary choledocholithiasis, recurrent ascending cholangitis, recurrent acute pancreatitis, and pancreatic atrophy due to giant juxtapapillary duodenal diverticulum, with unsuccessful endoscopic retrograde cholangiopancreatography that was completely resolved after open transduodenal sphincteroplasty and septoplasty, transampullary and transcystic common bile duct exploration and stone extraction, and duodenal diverticular inversion. OUTCOME: Complete resolution of combined pancreaticobiliary obstruction without recurrence for 2 years after surgery. LESSONS: Surgeons should be aware of such rare syndromes to avoid misdiagnosis and delayed or inappropriate management. Furthermore, they should understand the different available operative options for cases that are refractory to endoscopic approach.

Colangite/complicações , Divertículo/complicações , Icterícia/etiologia , Pancreatite/complicações , Dor Abdominal/etiologia , Atrofia , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Coledocolitíase/complicações , Colestase/etiologia , Colestase/patologia , Diverticulite/complicações , Divertículo/patologia , Divertículo/cirurgia , Neoplasias Duodenais/patologia , Feminino , Humanos , Indonésia/etnologia , Pancreatopatias/patologia , Recidiva , Esfincterotomia Transduodenal/métodos , Resultado do Tratamento , Adulto Jovem
J Surg Res ; 238: 41-47, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30738357


BACKGROUND: Management of Sphincter of Oddi Dysfunction (SOD) requires advanced techniques (endoscopic retrograde cholangiopancreatography via gastrostomy [GERCP]) after Roux-en-Y gastric bypass (RYGB) for obesity. Transduodenal sphincteroplasty (TS) is also performed yet carries the risks of surgery. We hypothesized that TS would have increased morbidity and mortality but provide a more durable remission of symptoms. METHODS: All patients between 2005 and 2016 with RYGB for obesity undergoing endoscopic or surgical management for type I or II SOD were included in the study. Patients with type III SOD, or who underwent RYGB for nonobesity indications, were excluded. RESULTS: Thirty-eight patients were identified. GERCP was initially performed in 17 patients, whereas TS was performed in 21. Thirty-day mortality was 0% in our cohort, and 30-d morbidity was similar between GERCP and TS (29% versus 10%; P = 0.207). Resolution of symptoms after initial therapy was seen in 41% of GERCP (7/17) and 67% of TS (14/21) (P = 0.190), respectively, and overall after 35% (8/23) and 64% (16/24) of procedures performed (P = 0.042). Symptom resolution, as defined by the median ratio of days of total remission by total days of observed follow-up, was shorter after initial and all interventions with GERCP compared with TS (0.67 versus 1.00, P = 0.036 and 0.52 versus 1.00, P = 0.028, respectively). CONCLUSIONS: Endoscopic and surgical treatment of SOD had similar morbidity and mortality. However, treatment success and duration of remission was higher in those treated with surgery.

Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Derivação Gástrica/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Disfunção do Esfíncter da Ampola Hepatopancreática/terapia , Esfincterotomia Transduodenal/efeitos adversos , Adulto , Idoso , Tomada de Decisão Clínica , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Esfíncter da Ampola Hepatopancreática/diagnóstico por imagem , Esfíncter da Ampola Hepatopancreática/patologia , Esfíncter da Ampola Hepatopancreática/cirurgia , Disfunção do Esfíncter da Ampola Hepatopancreática/etiologia , Disfunção do Esfíncter da Ampola Hepatopancreática/mortalidade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
J. coloproctol. (Rio J., Impr.) ; 37(3): 232-237, July-Sept. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-893984


Abstract Introduction The ideal method of treating the complex anal fistula is to eradicate the sepsis and preserve the anal sphincter; since there is no definite consensus on the surgical method of treating it. Recent studies show that fistulectomy and immediate sphincteroplasy are a safe and appropriate way to treat the fistula-in-ano. The aim of this study was to evaluate the long term outcomes of fistulectmy and sphincteroplasty in the treatment of complex perianal fistula. Methods In this prospective study, we have analyzed the data of 80 patients who underwent fistulectomy and sphincteroplasty from May 2013 to May 2016. Preoperative information included physical examination, preoperative fecal incontinence evaluation and taking a complete history about underlying diseases and past related surgeries were collected. Results Of all 80 patients with complex fistula, 57.5% (46 patients) were male. 70-Patients were presented with high transsphincteric fistula (87.5%) and anterior fistula was diagnosed in 10 of them (12.5%). 9 patients (11.3%) suffered from hypertension and 43 patients (53.75%) had recurrent fistula after previous surgeries. During the follow-up period, the overall success rate was 98.8% (98.8%) and fistulectomy and sphincteroplasty failed in only one patient (failure rate: 1.3%). preoperative and post-operative scoring showed mild fecal incontinence in 8 patients (10%). We have found no significant relation between the age, gender, hypertension, previous surgery and post-operative recurrence. Conclusion Fistulectomy and sphincteroplasty is a safe surgical procedure in the treatment of anterior anal fistula in females and high transsphincteric fistulas.

Resumo Introdução o método ideal para tratar a fístula anal complexa consiste em erradicar a sepse e preservar o esfíncter anal, uma vez que não existe consenso definitivo com relação ao método cirúrgico para tratamento desse problema. Estudos recentes demonstram que a fistulectomia, seguida imediatamente pela esfincteroplastia, é procedimento seguro e apropriado no tratamento da fístula perianal. O objetivo deste estudo foi avaliar os resultados em longo prazo da fistulectomia e da esfincteroplastia no tratamento da fístula perianal complexa. Métodos Neste estudo prospectivo analisamos os dados de 80 pacientes tratados por fistulectomia e esfíncteroplastia no período de maio de 2013 até maio de 2016. Foram coletadas as seguintes informações pré-operatórias: exame físico, avaliação pré-operatória de incontinência fecal e história completa sobre doenças subjacentes e cirurgias prévias afins. Resultados De todos os 80 pacientes com fístula complexa, 57,5% (46 pacientes) pertenciam ao gênero masculino. Setenta pacientes se apresentaram com fístula trans-esfinctérica alta (87,5%); em 10 desses pacientes (12,5%), foi diagnosticada fístula anterior. Nove pacientes (11,3%) sofriam de hipertensão (HT), tendo sido observada recorrência de fístula após cirurgias prévias em 43 pacientes (53,75%). Durante o período de seguimento, o percentual de sucesso global foi de 98,8%, e em apenas um paciente os procedimentos de fistulectomia e esfincteroplastia não obtiveram sucesso (percentual de falha: 1,3%). Os escores pré-operatórios e pós-operatórios revelaram incontinência fecal leve em 8 pacientes (10%). Não observamos nenhuma relação significativa entre idade, gênero, HT, cirurgia prévia e recorrência pós-operatória. Conclusão Fistulectomia e esfincteroplastia constituem procedimento cirúrgico seguro no tratamento de fístulas anais anteriores em mulheres e de fístulas trans-esfinctéricas altas.

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Períneo/lesões , Esfincterotomia Transduodenal/métodos , Fístula Retal/complicações , Resultado do Tratamento , Fístula Retal/diagnóstico
J. coloproctol. (Rio J., Impr.) ; 37(2): 95-99, Apr.-June 2017.
Artigo em Inglês | LILACS | ID: biblio-893967


ABSTRACT Purpose: Anal incontinence is a very stigmatizing condition, which affects biopsychosocially the patient. It is a neglected, but quite common complication of obstetric and anorectal surgery, however it has treatment options. None of the treatment options have exceptional efficacy rates and still associated with risk of recurrence. The surgery techniques known are: anterior and posterior shortening procedure; post-anal repair; anterior elevator plasty and external sphincter plication; total pelvic floor repair and sphincter repair. None of them use a flap rotation of adipose tissue. The purpose is to propose a new surgery technique of anal sphincteroplasty, which uses flap rotation, for severe perineal deformity associated with anal incontinence. Methods: Patient with severe perineal deformity and anal incontinence treated with a new surgery technique of sphincteroplasty with flap rotation. Results: The severe perineal deformity was corrected with both esthetic and functional results. Anal continence measured by Wexner and Jorge assessment in a follow-up period of 2 years after the intervention. Pictures and video show esthetic and functional aspects. Conclusion: This is the first time that a flap rotation is used to treat a severe perineal deformity. And the technique presented promising outcomes, which allows perineum reconstruction that is similar to the original anatomy. Therefore, this technique is justified to better evaluate its efficiency and the impact on patients' prognosis.

RESUMO Objetivo: A incontinência anal é uma condição muito estigmatizante, que afeta biopsicossocialmente o paciente. É uma complicação negligenciada, mas bastante comum da cirurgia obstétrica e anorretal, no entanto, tem opções de tratamento. Nenhuma das opções de tratamento tem taxas de eficácia excepcionais e ainda está associada ao risco de recorrência. As técnicas cirúrgicas conhecidas são: procedimento de encurtamento anterior e posterior; reparação pós-anal; plástica do elevador anterior e plicatura externa do esfíncter; reparo total do assoalho pélvico e reparo do esfíncter. Nenhum deles utiliza uma rotação de retalho de tecido adiposo. O objetivo é propor uma nova técnica cirúrgica de esfincteroplastia anal, que utiliza a rotação de retalho, para deformidade perineal grave associada à incontinência anal. Métodos: Paciente com deformidade perineal grave e incontinência anal tratada com nova técnica cirúrgica de esfincteroplastia com rotação de retalho. Resultados: A deformidade perineal grave foi corrigida com resultados estéticos e funcionais. Continência anal medida pela avaliação de Wexner & Jorge em um período de seguimento de 2 anos após a intervenção. Imagens e vídeo mostram aspectos estéticos e funcionais. Conclusão: Esta é a primeira vez que uma rotação de retalho é usada para tratar uma deformidade perineal grave. E a técnica apresentou resultados promissores, o que permite a reconstrução do períneo semelhante à anatomia original. Portanto, esta técnica é justificada para melhor avaliar sua eficiência e o impacto no prognóstico dos pacientes.

Humanos , Feminino , Adulto , Retalhos Cirúrgicos , Esfincterotomia Transduodenal/métodos , Incontinência Fecal/cirurgia , Períneo/anormalidades
Stem Cell Res Ther ; 8(1): 40, 2017 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-28222801


BACKGROUND: Anal sphincter defects are a major cause of fecal incontinence causing negative effects on daily life, social interactions, and mental health. Because human adipose-derived stromal/stem cells (hADSCs) are easier and safer to access, secrete high levels of growth factor, and have the potential to differentiate into muscle cells, we investigated the ability of hADSCs to improve anal sphincter incontinence. METHODS: The present randomized double-blind clinical trial was performed on patients with sphincter defects. They were categorized into a cell group (n = 9) and a control group (n = 9). Either 6 × 106 hADSCs per 3 ml suspended in phosphate buffer saline (treatment) or 3 ml phosphate buffer saline (placebo) was injected. Two months after surgery, the Wexner score, endorectal sonography, and electromyography (EMG) results were recorded. RESULTS: Comparing Wexner scores in the cell group and the control group showed no significant difference. In our EMG and endorectal sonography analysis using ImageJ/Fiji 1.46 software, the ratio of the area occupied by the muscle to total area of the lesion showed a 7.91% increase in the cell group compared with the control group. CONCLUSION: The results of the current study show that injection of hADSCs during repair surgery for fecal incontinence may cause replacement of fibrous tissue, which acts as a mechanical support to muscle tissue with contractile function. This is a key point in treatment of fecal incontinence especially in the long term and may be a major step forward. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT2016022826316N2 . Retrospectively registered 7 May 2016.

Adipócitos/citologia , Incontinência Fecal/terapia , Células Musculares/citologia , Transplante de Células-Tronco , Células-Tronco/citologia , Adipócitos/fisiologia , Tecido Adiposo/citologia , Tecido Adiposo/fisiologia , Adulto , Idoso , Canal Anal/diagnóstico por imagem , Canal Anal/fisiopatologia , Canal Anal/cirurgia , Diferenciação Celular , Método Duplo-Cego , Eletromiografia , Incontinência Fecal/diagnóstico por imagem , Incontinência Fecal/fisiopatologia , Incontinência Fecal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Células Musculares/fisiologia , Esfincterotomia Transduodenal/métodos , Células-Tronco/fisiologia , Transplante Homólogo , Ultrassonografia
Expert Rev Gastroenterol Hepatol ; 10(12): 1359-1372, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27762149


INTRODUCTION: Post-cholecystectomy syndrome and the concept of a causal relationship to sphincter of Oddi dysfunction, despite the controversy, has presented a clinically relevant conflict for decades. Historically surgeons, and now gastroenterologists have expended tremendous efforts towards trying to better understand the dilemma that is confounded by unique patient phenotypes. Areas covered: This review encompasses the literature from a century of experience on the topic of post-cholecystectomy syndrome. Relevant historical and anecdotal experiences are examined in the setting of insights from evaluation of recently available controlled data. Expert commentary: Historical observations and recent data suggest that patients with post-cholecystectomy syndrome can be categorized as follows. Patients with sphincter of Oddi stenosis will most often benefit from treatment with sphincterotomy. Patients with classic biliary pain and some objective evidence of biliary obstruction may have a sphincter of Oddi disorder and should be considered for endoscopic evaluation and therapy. Patients with atypical post-cholecystectomy pain, without any evidence consistent with biliary obstruction, and/or with evidence for another diagnosis or dysfunction should not undergo ERCP.

Colecistectomia/efeitos adversos , Disfunção do Esfíncter da Ampola Hepatopancreática/etiologia , Esfíncter da Ampola Hepatopancreática/fisiopatologia , Dor Abdominal/etiologia , Humanos , Valor Preditivo dos Testes , Reoperação , Fatores de Risco , Esfíncter da Ampola Hepatopancreática/cirurgia , Disfunção do Esfíncter da Ampola Hepatopancreática/diagnóstico , Disfunção do Esfíncter da Ampola Hepatopancreática/fisiopatologia , Disfunção do Esfíncter da Ampola Hepatopancreática/cirurgia , Esfinterotomia Endoscópica , Esfincterotomia Transduodenal , Síndrome , Resultado do Tratamento
Klin Khir ; (6): 11-4, 2015 Jun.
Artigo em Russo | MEDLINE | ID: mdl-26521457


We analyzed the immediate and long-term results of endoscopic diagnostic and therapeutic interventions in patients on the non-tumor obstruction of the bile ducts. Application of the developed diagnostic algorithm using ultrasound, fistulocholangiography, computer and magnetic resonance imaging, endoscopic retrograde cholangiopancreatography, diagnostic endoscopic papillosphincterotomy, instrumental revision of bile ducts, transduodenal holedohoscopy provided sensitive diagnostic reasons of non-tumor biliary obstruction to (94.2 +/- 1.7)%. Optimization of treatment strategy developed with the introduction of the clinic endobiliary endoscopic intervention has achieved positive results in 83.7% of patients, reducing the morbidity of 1.7%, mortality--0.9%.

Ductos Biliares/cirurgia , Esfincterotomia Transduodenal/métodos , Adulto , Idoso , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/patologia , Colangiografia/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Coledocostomia/métodos , Humanos , Esfinterotomia Endoscópica/métodos , Resultado do Tratamento , Ultrassonografia
Eur Radiol ; 25(8): 2437-44, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25693665


OBJECTIVES: To evaluate secretin-enhanced MRCP (S-MRCP) findings of patients with pancreas divisum and Santorinicele, before and after minor papilla sphincterotomy. METHODS: S-MRCP examinations of 519 patients with suspected pancreatic disease were included. Size of the main pancreatic duct, presence and calibre of Santorinicele were evaluated. Duodenal filling was assessed on dynamic images. After sphincterotomy the same parameters and the clinical findings were re-evaluated. RESULTS: Pancreas divisum was depicted in 55/519 patients (11 %) by MRCP and an additional 26/519 by S-MRCP (total 81/519, 16 %). Santorinicele was detected in 7/81 patients (8.6 %) with pancreas divisum by MRCP and an additional 20/81 by S-MRCP (total 27/81, 33 %). Dorsal duct in patients with Santorinicele was significantly larger in the head compared with patients with only pancreas divisum (p < 0.01), in basal conditions (average 2.4 versus 1.9 mm) and after secretin administration (average 3.0 versus 2.4 mm). Duodenal filling was impaired in 11/27 patients (41 %) with Santorinicele. After sphincterotomy significant reduction in size of Santorinicele (-33 %) and dorsal duct (-17 %), increase of pancreatic juice and symptoms improvement were observed. CONCLUSION: Secretin administration increases the accuracy of MRCP in detecting Santorinicele and demonstrates the impaired duodenal filling. S-MRCP is useful to assess results of sphincterotomy. KEY POINTS: • Secretin-enhanced MRCP gives anatomical and functional information on pancreatic outflow dynamics. • Santorinicele is a cystic dilatation of the termination of the Santorini duct. • S-MRCP images are the most useful to recognize the presence of Santorinicele. • Minor papilla sphincterotomy during ERCP is indicated in patients with Santorinicele.

Meios de Contraste , Pâncreas/anormalidades , Cisto Pancreático/patologia , Secretina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia por Ressonância Magnética/métodos , Dilatação Patológica/patologia , Dilatação Patológica/cirurgia , Duodeno/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cisto Pancreático/cirurgia , Ductos Pancreáticos/patologia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Esfincterotomia Transduodenal/métodos , Adulto Jovem
World J Gastroenterol ; 21(6): 2000-4, 2015 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-25684970


Bile duct stones are a serious and the third most common complication of the biliary system that can occur following liver transplantation. The incidence rate of bile duct stones after liver transplantation is 1.8%-18%. The management of biliary stones is usually performed with endoscopic techniques; however, the technique may prove to be challenging in the treatment of the intrahepatic bile duct stones. We herein report a case of a 40-year-old man with rare, complex bile duct stones that were successfully eliminated with percutaneous interventional techniques. The complex bile duct stones were defined as a large number of bile stones filling the intra- and extrahepatic bile tracts, resulting in a cast formation within the biliary tree. Common complications such as hemobilia and acute pancreatitis were not present during the perioperative period. The follow-up period was 20 mo long. During the postoperative period, the patient maintained normal temperature, and normal total bilirubin and direct bilirubin levels. The patient is now living a high quality life. This case report highlights the safety and efficacy of the percutaneous interventional approach in the removal of complex bile duct stones following liver transplantation.

Cateterismo/métodos , Colelitíase/terapia , Drenagem/métodos , Transplante de Fígado/efeitos adversos , Radiografia Intervencionista/métodos , Adulto , Cateterismo/instrumentação , Cateteres , Colangiopancreatografia por Ressonância Magnética , Colelitíase/diagnóstico , Colelitíase/etiologia , Drenagem/instrumentação , Desenho de Equipamento , Humanos , Masculino , Radiografia Intervencionista/instrumentação , Esfincterotomia Transduodenal , Resultado do Tratamento
Rev. latinoam. enferm ; 22(6): 918-925, 16/12/2014. graf
Artigo em Inglês | LILACS, BDENF - Enfermagem | ID: lil-732957


OBJECTIVE: to analyze the meanings Primary Health Care users attribute to their health-disease process and the services used. METHODS: this qualitative research uses the focus group technique to interview two groups of users the service monitors. The first is a group of elderly people and the second of pregnant women. To analyze the meanings, the discourse analysis technique and the reference framework of health promotion are used. RESULTS: the group of elderly, being mostly female arterial hypertension and diabetes mellitus patients, visualizes the health-disease process as the evolution of human existence controlled by divine power, signifying the health service as a blessing in the control of the disease. The Group of young pregnant women signified health as the ability for self-care and disease as the disability for that purposes, considering the Primary Health Care service as responsible for the recovery of individual and family health. FINAL CONSIDERATIONS: the users demonstrated dissatisfaction with bureaucratic and vertical relations present at the health services. In each group, it was observed that the meanings for health and disease and meanings of the health service the users elaborated can be related. .

OBJETIVO: analisar os significados atribuídos pelos usuários da Atenção Primária à Saúde ao seu processo de saúde/doença e aos serviços utilizados. MÉTODOS: pesquisa qualitativa utilizando a técnica do grupo focal para entrevista com dois grupos de usuários acompanhados pelo serviço, sendo o primeiro um grupo de idosos e o segundo, de mulheres gestantes. Para análise dos significados, usou-se a técnica de análise de discurso e referencial da promoção em saúde. RESULTADOS: grupo de idosos, maioria feminina, portadores de hipertensão arterial e diabetes mellitus, visualiza o processo de saúde/doença como evolução da existência humana controlada pelo poder divino, significando o serviço de saúde como uma bênção no controle da doença. O grupo de gestantes jovens significou saúde como capacidade para autocuidado e doença como incapacidade para tal, concebendo o serviço de Atenção Primária como responsável pela recuperação da saúde individual e familiar. CONSIDERAÇÕES FINAIS: os usuários demonstraram insatisfação com relações burocratizadas e verticalizadas presentes no serviço de saúde. Observou-se, em cada grupo, que significados para saúde e doença e significados do serviço de saúde elaborados pelos usuários podem estar relacionados. .

OBJETIVO: analizar los significados atribuidos por los usuarios de la Atención Primaria de la Salud al proceso salud-enfermedad y a los servicios utilizados. MÉTODOS: investigación cualitativa que utiliza la técnica del grupo focal para entrevistar a dos grupos de usuarios acompañados por el servicio, el primer grupo de ancianos y el segundo de mujeres embarazadas. Para el análisis de los significados, fue usada la técnica de análisis de discurso y el referencial de la promoción de la salud. RESULTADOS: grupo de ancianos, mayoría femenina, con hipertensión arterial y diabetes mellitus, entiende el proceso salud-enfermedad como una evolución de la existencia humana controlada por el poder divino, significando al servicio de salud como una bendición para el control de la enfermedad. Para el Grupo de embarazadas jóvenes significó: la salud como una capacidad para el autocuidado y la enfermedad como la incapacidad para eso, concibiendo al servicio de Atención Primaria como responsable por la recuperación de la salud individual y familiar. CONSIDERACIONES FINALES: los usuarios demostraron insatisfacción con las relaciones burocratizadas y verticales, presentes en el servicio de salud. Se observó en cada grupo que los significados para salud y enfermedad y los significados del servicio de salud elaborados por los usuarios pueden estar relacionados. .

Humanos , Colelitíase/terapia , Doenças dos Ductos Biliares/terapia , Caprilatos , Colecistectomia , Endoscopia , Glicerídeos/administração & dosagem , Litotripsia , Complicações Pós-Operatórias/terapia , Esfincterotomia Transduodenal , Solventes/administração & dosagem , Irrigação Terapêutica/métodos
Rev. bras. enferm ; 67(6): 928-935, Nov-Dec/2014. tab
Artigo em Português | LILACS, BDENF - Enfermagem | ID: lil-732810


Objetivou-se analisar a comunicação não verbal entre enfermeiros e idosos na consulta de enfermagem à luz do referencial teórico de Hall. Estudo exploratório descritivo com abordagem quantitativa, realizado por filmagens das consultas de enfermagem com idosos em Unidades Básicas de Saúde do município de João Pessoa-Paraíba, analisadas a cada um minuto, totalizando 1.575 interações não verbais. A análise mostra predomínio de enfermeiros (90,63%) e idosos (65,63%) do sexo feminino e classificação regular para a maioria dos fatores com prevalência da postura sentada (80,09%), cadeiras uma em frente a outra (64,46%), distância pessoal (91,40%), expressão facial tranquila (59,78%), uso do toque apenas ao realizar um procedimento técnico (53,33%), interação visual enquanto manipula objetos (57,69%) e volume de voz inalterado (48,79%). Esses resultados refletem a necessidade de os enfermeiros dominarem conscientemente suas manifestações corporais e faciais a fim de melhor interagirem com o idoso.

The aim is to analyze the nonverbal communication between nurses and the elderly in the nursing consultation based on the theory by Hall. The research concerns a descriptive exploratory study and it has a quantitative approach. It took place through filmings of the nursing consultations which happened in Health Basic Units in João Pessoa, Paraíba, Brazil, observed every minute, a total of 1.575 nonverbal interactions. The analysis has showed the predominance of the female nurses (90.63%) and the elderly (65.63) and a regular classification for most of the factors as a prevalence of a sitting set (80.09), opposite chairs (64.46%), personal distance (91.40%), calm facial expression (59.78%), touch was used for a technical procedure (53.33%), visual interaction for the manipulation of the objects (57.69) and no alteration in the voice volume (48.79%). These results reflect the necessity of the nurses to domain consciously their corporal and facial manifestations in order to improve the interaction with the elderly.

El objetivo es analizar la comunicación no verbal entre enfermeros y ancianos en la consulta de enfermería bajo la teoría de Hall. Estudio exploratório descriptivo con abordaje cuantitativa, realizada a través de filmaciones de consultas con ancioanos en Unidades Básicas de Saúde de João Pessoa - Paraíba, totalizando 1.1575 interacciones no verbales. El análisis muestra predomínio de enfermeros (60,63%) y ancianos (65,63%) de sexo femenino y classificación Regular para la mayoría de factores con predominio de postura sentada (80,09%), sillas una frente a otra (64,46%), distancia personal (91,40%), expresión facial tranquila (59,78%), uso de contacto sólo para realizar procedimientos técnicos (53,33%), interacción visual cuando manipula objetos (57,69%) y volumen de voz inalterado (48,79%). Estos resultados reflejan la necessidad de que los enfermeros dominen conscientemente manifestaciones corporales y faciales a fin de mejorar la interacción con el anciano.

Humanos , Colelitíase/terapia , Éteres Metílicos , Ácidos e Sais Biliares/uso terapêutico , Caprilatos , Colelitíase/tratamento farmacológico , Colelitíase/enfermagem , Educação Continuada em Enfermagem , Endoscopia , Éteres/uso terapêutico , Glicerídeos/uso terapêutico , Litotripsia , Esfincterotomia Transduodenal
BMJ Case Rep ; 20142014 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-25100803


Gangliocytic paragangliomas are rare neuroendocrine tumours residing in the gastrointestinal tract, most commonly the periampullary region. Most are benign tumours with a low malignancy rate. We report a 50-year-old man who presented with acute onset of left-upper quadrant abdominal pain with radiation to the back. An intraluminal mass at the junction of the duodenum with normal pancreatic/hepatic parenchyma was discovered on abdominal CT. Following upper endoscopy and MRI revealing a periampullary lesion, fine-needle aspiration and biopsies were. Immunohistochemistry was positive for synaptophysin and S100HU, consistent with gangliocytic paraganglioma. The benign nature of this tumour and unique anatomy of a separate opening of the pancreatic and common bile ducts led to transduodenal excision with sphincteroplasty, thereby avoiding extensive surgery. Surveillance CT every 6 months and upper endoscopy initially every 6 months (now yearly) revealed no evidence of endoscopic or histological recurrence at 3 years follow-up.

Ampola Hepatopancreática , Neoplasias Duodenais/cirurgia , Laparotomia/métodos , Paraganglioma/cirurgia , Esfíncter da Ampola Hepatopancreática/cirurgia , Esfincterotomia Transduodenal/métodos , Biópsia por Agulha Fina , Colecistectomia/métodos , Diagnóstico Diferencial , Neoplasias Duodenais/diagnóstico , Duodenoscopia , Endossonografia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Paraganglioma/diagnóstico , Tomografia Computadorizada por Raios X
Clin Ter ; 164(5): e353-8, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24217834


BACKGROUND: Choledocholithiasis is increasing in elderly subjects. The introduction of endoscopic retrograde cholangiopancreatography with biliary sphincterotomy has almost replaced surgery in the treatment of this condition. The aim of the present study was to evaluate the rates of successful clearance of common bile duct stones and the endoscopic techniques used in a population aged 75 years or older compared with those in a younger age group. MATERIALS AND METHODS: A retrospective analysis was made of data related patients who underwent endoscopic retrograde cholangiopancreatography for choledocolithiasis in the period 2010-2011. For all patients, factors such as sex, age at diagnosis, endoscopic treatment (stone extraction using baskets and balloon, mechanical lithotripsy and balloon dilatation of the ampulla, placement of a stent or a naso-biliary tube) and need of surgery were analysed. Two groups of patients were identified: patients aged <75 years (Group A) and patients aged ≥75 years (Group B). For the statistical analysis Mann-Whitney test and Fischer's Exact test were used. RESULTS: A total of 234 patients were enrolled in the study (94 in Group A, 140 in Group B). No statistically significant differences were observed as far concerns sex, previous cholecystectomy, gallbladder stones and periampullary diverticula, but only for common bile duct dilatation. Complete clearance of common bile duct stones was achieved in 230 patients (97.5%). CONCLUSIONS: The present data are in keeping with those presented in the literature, which confirm that endoscopic retrograde cholangiopancreatography is a safe and effective procedure also in older patients.

Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/diagnóstico por imagem , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangite/epidemiologia , Colecistectomia/estatística & dados numéricos , Colelitíase/epidemiologia , Comorbidade , Duodenoscopia , Desenho de Equipamento , Feminino , Fluoroscopia , Cálculos Biliares/epidemiologia , Cálculos Biliares/cirurgia , Humanos , Intubação , Litotripsia , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estudos Retrospectivos , Esfinterotomia Endoscópica , Esfincterotomia Transduodenal , Stents , Resultado do Tratamento