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The purpose of this article is to present a well-known physician and highlight his contribution into an essential, but neglected anatomical feature. George Sclavunos (1869-1954) was a 20th century Greek physician, whose scientific work was a significant milestone in global medical knowledge. In 1899 he became Professor of Anatomy and Head Director of the Department of Anatomy. In 1906 Sclavunos G. published the first volume of the three volume book "Human Anatomy" (1906-1926), which is characterized by its unparalleled illustrations. For more than a century it was the most important book of medical literature in Greece. In 1926 he became a Full Member of the Academy of Athens and was named Life Partner of the International Anatomical Society. His interests included Anatomy, Physiology, Histology, as well as Osteology and Syndesmology. In his book "Human Anatomy", he described for first time the "Sialine Groove of the Stomach", which was described by Waldeyer-Hartz almost at the same time as the "Magenstrasse", a German word that means "stomach road". It is a ribbon-like path that extends along the lesser curvature of the stomach from the gastric cardia to the antrum and releases the gastric content directly into the small intestine. Its importance is confirmed by its association not only with drug delivery, but also with anti-obesity surgical techniques. The old German term has come back into common medical usage in view of the commonly performed Magenstrasse and Mill procedure, a form of bariatric surgery. CONCLUSION: Sclavunos G. managed to observe an anatomical structure that has remained of great importance until today.
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Anatomia , Anatomia/história , Humanos , Grécia , História do Século XX , História do Século XIX , Estômago/anatomia & histologiaRESUMO
Objectives:The purpose of this systematic review is to examine the different variations of the median nerve (MN) and the diagnostic methods used to identify carpal tunnel syndrome (CTS), a common neuropathy resulting from the entrapment of the MN within the carpal tunnel. Understanding the different variations of the MN is crucial in order to prevent injuries during surgical treatment of the syndrome. Materials and methods:Data were extracted from studies published in PubMed. A detailed search in PubMed was performed for studies that reviewed the variations of the MN and CTS. Results:There are two main classifications of the MN, known as the Lanz and Amadio categories. Lanz's classification is the one being mostly used in the surgical literature, with group 3 (Bifid MN) being the main cause of the CTS. Additionally, there are branches and anastomosis of the MN that do not fit into either category, with the third common digital branch being the most injured nerve during carpal tunnel release surgery. Diagnostic techniques for CTS include physical examination combined with NCS tests, magnetic resonance imaging (MRI), ultrasound, or elastography. While NCS has been previously the most commonly used diagnostic method, the recent literature suggests that ultrasound and elastography are the most accurate techniques. Conclusions:In order to minimize injuries during carpal tunnel release surgery, it is crucial to have knowledge on the different variations of the MN that cause CTS. Additionally, this review emphasizes the significance of the current diagnostic methods, which not only make CTS more affordable but also facilitate easier recognition of the condition.
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ABSTRACT Objective To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA. Materials and Methods We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered. Results Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identified with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases. On doppler evaluation, mean blood flow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a significant difference between between pre-intervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a significant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was 100%. Conclusions Endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS, ensuring the functionality of the graft and normalization of blood pressure and renal function.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Idoso , Adulto Jovem , Obstrução da Artéria Renal/cirurgia , Obstrução da Artéria Renal/etiologia , Transplante de Rim/efeitos adversos , Angioplastia/métodos , Obstrução da Artéria Renal/diagnóstico por imagem , Fatores de Tempo , Pressão Sanguínea/fisiologia , Angiografia/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise de Variância , Seguimentos , Resultado do Tratamento , Creatinina/sangue , Pessoa de Meia-IdadeRESUMO
PURPOSE: To analyze the outcome of deceased donor recipients given priority in allocation due to lack of access for dialysis and compare this data to the one obtained from non-prioritized deceased donor kidney transplant recipients. MATERIALS AND METHODS: we reviewed electronic charts of 31 patients submitted to kidney transplantation that were given priority in transplantation program due to lack of access for dialysis from January 2005 to December 2008. Immunological and surgical complications rates, and grafts and patients survival rates were analyzed. These data were compared to those obtained from 100 regular patients who underwent kidney transplantation without allocation priority during the same period. RESULTS: Overall surgical complication rate was 25.8% and 27% in the patients with priority in allocation and in the non-prioritized patients, respectively. There was no statistical significant difference for surgical complications (p = 1.0), immunological complications (p = 0.21) and graft survival (p = 0.19) rates between the groups. However, patient survival rate was statistically significant worse in prioritized patients (p = 0.05). CONCLUSIONS: patients given priority in allocation owing to lack of access for dialysis have higher mortality rate when compared to those non-prioritized.
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Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Falência Renal Crônica/cirurgia , Transplante de Rim/estatística & dados numéricos , Seleção de Pacientes , Diálise Renal/estatística & dados numéricos , Brasil , Sobrevivência de Enxerto , Acessibilidade aos Serviços de Saúde , Falência Renal Crônica/mortalidade , Taxa de Sobrevida , Fatores de Tempo , Doadores de Tecidos/estatística & dados numéricosRESUMO
OBJECTIVES: urinary fistula is a morbid complication after renal transplantation leading to graft losses and patient death. We review and update our data on urinary fistula after renal transplantation and the outcome after surgical and conservative management. MATERIALS AND METHODS: the charts of 1046 renal transplants were reviewed. Transplants were performed through an extended inguinotomy; vascular anastomoses to the iliac vessels and urinary reconstruction accomplished through the Gregoir technique. Fistulae were diagnosed by urinary leaks through the incision or by the occurrence of a collection in the iliac fossa. Patient was treated surgically or conservatively according to the characteristics of the fistula and patient clinical status. RESULTS: Thirty one fistulae were diagnosed (2.9 percent). Twenty nine leaks due to ureteral necrosis and 2 due to reimplantation fault. The incidence of leaks among cadaver and live donor transplants was 3.22 percent and 2.63 percent, respectively (p = 0.73). Among diabetic and non diabetic patients the incidence of urinary leaks was 6.4 percent and 2.6 percent, respectively (p = 0.049). Treatment consisted in anastomosis of the graft ureter or pelvis with the ureter of the recipient in 17 cases with success in 13 (76.5 percent). Prolonged bladder drainage was employed in 7 cases and the fistula healed in 4 (57 percent). Ureteral reimplantation was performed in 3 cases and did not work in any of them. Ureteral ligature plus nephrostomy was employed in two cases and worked in one (50 percent). Percutaneous nephrostomy and ureteral stenting with double J catheter were employed in one case each and worked in both. CONCLUSIONS: The anastomosis of the graft ureter with the ureter of the recipient is a good method for treating urinary fistulae after renal transplantation when local and systemic conditions are good. Ureteral ligature associated to nephrostomy should be applied in cases of unfavorable local conditions or clinically unstable patients.
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Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Rim/efeitos adversos , Fístula Urinária/cirurgia , Seguimentos , Estudos Retrospectivos , Resultado do Tratamento , Fístula Urinária/etiologia , Fístula Urinária/terapiaRESUMO
OBJECTIVES: To evaluate the likelihood of retrograde double-J stenting in urgent ureteral drainage according to obstructing pathology. MATERIALS AND METHODS: From July 2002 to January 2003, 43 consecutive patients with ureteral obstruction who needed urgent decompression were evaluated at our institution, where we performed a total of 47 procedures. Emergency was defined as ureteral obstruction associated with infection, obstructive acute renal failure, or refractory pain. Ureteral obstruction was defined as intrinsic and extrinsic based on etiology and evaluated by ultrasound. Patients submitted to previous double-J stenting were excluded. Failures in retrograde ureteral stenting were treated with percutaneous nephrostomy. Results were analyzed with Fisher's exact test and regression analysis. RESULTS: Failure in retrograde ureteral stenting occurred in 9 percent (2/22) and 52 percent (13/25) of the attempts in patients with intrinsic and extrinsic obstruction respectively (p < 0.001). Failures in stenting extrinsic obstructions occurred due to lack of identification of the ureteral meatus in 77 percent and impossibility of catheter progression in 23 percent (p < 0.05). All attempts of retrograde catheter insertion failed in obstructions caused by prostate or bladder pathologies (6/6). Inability to identify the ureteral meatus was the cause of all failures. CONCLUSION: Retrograde double-J stenting has a low probability of success in extrinsic ureteral obstruction caused by prostate or bladder disease. Such cases might be best managed with percutaneous nephrostomy.
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Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Descompressão Cirúrgica/métodos , Drenagem/instrumentação , Nefrostomia Percutânea/métodos , Stents , Obstrução Ureteral/cirurgia , Estudos Prospectivos , Análise de Regressão , Resultado do Tratamento , Obstrução Ureteral/etiologiaRESUMO
INTRODUCTION: Renal transplantation with multiple arteries appears, in literature, associated to a major index of surgical complications. This study compared the surgical complications and short-term outcome renal transplants with multiple arteries and single artery grafts. MATERIALS AND METHODS: The data of 64 renal transplants with multiple arteries performed between January 1995 and December 1999 were compared to the ones of 292 transplants with single renal artery. The aspects analyzed were number of arteries of the graft, donor type, vascular reconstruction technique, the occurrence of surgical complications, the incidence of delayed graft function, graft function 1 month after transplantation, graft loss and the patients' deaths. RESULTS: The incidence of surgical complications in grafts with multiple arteries and single renal artery was respectively: vascular - 3.1 percent and 3.1 percent; urological - 6.3 percent and 2.7 percent and other surgical complications - 15.6 percent and 10.6 percent, respectively. The incidence of lymphoceles was 3.1 percent in grafts with a single artery and 12.5 percent in grafts with more than 1 artery (p = 0.0015). The incidence of delayed graft function in grafts with multiple arteries and with a single renal artery was respectively 35.1 and 29.1 percent (p = 0.295). Mean serum creatinine at the 30th postoperative day was 2.46 and 1.81 in grafts with multiple and with 1 artery, respectively (p=0.271). CONCLUSIONS: Kidney transplantation using grafts with single and multiple arteries present similar indexes of surgical complications and short-term outcome; lymphoceles were more frequent among grafts with multiple arteries.
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Rim/efeitos adversos , Rim/irrigação sanguínea , Complicações Pós-Operatórias , Artéria Renal/cirurgia , Incidência , Nefropatias/terapia , Linfocele , Complicações Pós-Operatórias/epidemiologia , Estudos RetrospectivosRESUMO
Não é infreqüente ouvir que, em transplante renal, inovações de impacto no âmbito cirúrgico já não são mais prováveis. No entanto, soluções de alto impacto econômico ainda surgem com freqüência e muitas delas têm surgido no Brasil, contribuindo significativamente para a mudança de conduta cirúrgica em transplante renal a nível mundial. A técnica cirúrgica do transplante renal propriamente dita está bem estabelecida há anos, sendo muito parecida entre os diversos serviços de transplante. Já no que se refere ao tratamento cirúrgico das complicações do transplante e dos pacientes com doenças associadas à insuficiência renal crônica dialítica (IRCD), observamos considerável controvérsia e variação nas condutas. Este estudo pretende oferecer um panorama sobre as técnicas cirúrgicas utilizadas no transplante renal, as complicações decorrentes deste procedimento e os resultados obtidos pelo Serviço de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo...
Is not rare to hear that, on kidney transplantation, improvements on surgical aspects are not probable anymore. Although, solutions with high economical impact arises frequently and, many of them, in Brazil, contributing, significantly, for changes on surgical conduct on kidney transplantation worldwide. The surgical techniques for kidney transplantation are well established and do not change between the groups of transplants. Although, the surgical treatment of complicated outcomes and of patients with diseases related to chronic renal failure is still controversial. This study aims to offer a general overview about the surgical techniques of kidney transplantation, complications inherent to this procedure and the results obtained by the Kidney Transplantation Team of Clinic Hospital of São Paulo University Medical School.
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Hospitais de Ensino , Insuficiência Renal Crônica/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Transplante de Rim , Unidade Hospitalar de UrologiaRESUMO
Objetivo: Analisar descritivamente as diferenças etnicas na prevalência de câncer de próstata no Brasil. Materiais e métodos: Entre 1922 e 1997, 1773 homens foram submetidos a toque retal (TR), dosagem de PSA e questionário padrão (AUA-IPSS). Foram classificados etnicamente em amarelos (45 casos), brancos (1180 casos) e negróides (210 casos). Em 347 homens não foi possível definir a etnia. Os pacientes foram orientados a submeter-se a biópsia de próstata quando o PSA e/ou o TR estivessem alterados. Avaliou-se também o estádio clínico e escore de Gleason na ocasião do diagnóstico, sendo que as etnias foram comparadas quanto à prevalência de câncer. Resultados:Foram feitas 346 biópsias e diagnosticados 51 tumores (14,7 porcento de positividade nas biópsias). Dos tumores, 4 (7,8 porcento) apresentavam PSA normal, 16 (31,4 porcento) PSA entre 4,1 ng/ml e 10 ng/ml e 31 (60,8 porcento), PSA>10 ng/ml. A prevalência de câncer em brancos foi de 2,4 porcento e em negróides de 5,5 porcento (p<0,05). A média de idade para brancos foi de 62,3 ± 0,4 anos e para negróides 62,4 ± 0,7 anos (p>0,05). O PSA mediano para brancos foi 3 ng/ml e para negróides 3,3 ng/ml (p>0,05). Os negróides apresentaram maior prevalência de TR alterado (18,9 porcento versus 11,7 porcento, p<0,05). A instrução mediana de brancos foi 3 e a de negróides 2 (p<0,05). A prevalência de tumores clinicamente localizados foi de 61,3 porcento. Conclusões: A prevalência de câncer de próstata em negróides é maior do que em brancos (5,5 porcento versus 2,4 porcento). O PSA mediano foi similar em ambas etnias. Os negróides apresentaram maior prevalência de toque retal alterado (18,9 porcento versus 11,7 porcento).
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Pessoa de Meia-Idade , Humanos , Masculino , Epidemiologia , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/etnologia , Idoso de 80 Anos ou mais , Antígenos de Diferenciação , Exames Médicos , PrevalênciaRESUMO
Entre outubro de 1979 e novembro de 1993, foram realizados 78 transplantes renais em 73 crianças com idade entre um e 14 anos. Sessenta e dois transplantes foram realizados com doador vivo e 16 com doador-cadáver. Ocorreram oito complicaçöes cirúrgicas precoces (10,2 por cento) e quatro tardias (5,1 por cento) com quatro perdas de enxertos (5,1 por cento) no período de seguimento. Cinco complicaçöes foram de ordem vascular (6,4 por cento), seis urológicas (7,6 por cento) e uma linfocele. Houve maior incidência de complicaçöes vasculares em pacientes receptores de rim de doador-cadáver. A sobrevida atuarial de um ano do enxerto e do paciente foi de 85 por cento e 95 por cento respectivamente para receptores de rim de doador vivo e 56 por cento e 66 por cento para receptores de rim de doador-cadáver. Säo discutidos os fatores implicados na origem das complicaçöes e seu tratamento