Navegando por Palavras-chave "Cirurgia endoscópica por orifício natural"
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- ItemSomente MetadadadosEfeito da cirurgia endoscópica transluminal por orifícios naturais sobre os biomarcadores plasmáticos de resposta inflamatória aguda em suínos(Universidade Federal de São Paulo (UNIFESP), 2011) Rezende, Marcelo Ferreira Pinto [UNIFESP]; Libera Júnior, Ermelido Della [UNIFESP]A cirurgia endoscopica transluminal por orificios naturais (CETON, do ingles NOTES u oNatural Orifice Transluminal Endoscopic Surgeryo) e motivo de estudos quanto a sua viabilidade e seguranca. Entretanto, ate o momento, os estudos que avaliaram o impacto fisiologico da CETON comparada a outras modalidades cirurgicas obtiveram resultados pouco expressivos e conflitantes. O melhor entendimento das consequencias do trauma induzido por essa nova via de acesso cirurgico tem sido considerado estrategico para prevencao de complicacoes posoperatorias e viabilizacao dessa tecnica. Objetivos: O objetivo principal deste estudo foi avaliar o impacto do acesso peritoneal transgastrico sobre os biomarcadores plasmaticos de resposta inflamatoria aguda, comparado com os acessos por laparoscopia e laparotomia, em suinos. Teve como objetivo secundario descrever um modelo experimental para estudo de resposta inflamatoria aguda avaliada por medida de citocinas em suinos submetidos a CETON. Metodo: Para este estudo, 34 suinos Sus scrofa domesticus machos foram distribuidos em quatro grupos: peritonioscopia transgastrica (CETON, n= 12), laparoscopia (LPSC, n=8), laparotomia (LPT, n=8), e anestesia (ANEST, n=6) como grupo controle. Em todos esses animais foram colhidas amostras de sangue em seis tempos sequenciais. As coletas foram distribuidas da seguinte forma: T0=0 min; T1=1 hora; T3= 3 horas; T6=6 horas; T9= 9 horas e T24= 24 horas. Nesses momentos foram colhidos amostras de sangue para dosagem de interleucina 1 (IL-1), fator de necrose tumoral alfa (TNF- α), interleucina 6 (IL-6) e interleucina 10 (IL-10), atraves de imunoensaio enzimatico (ELISA). Em T0 e T24 tambem foram colhidas amostras de sangue para hemograma e proteina C reativa (PCR). Resultados: Os grupos CETON, LPSC e LPT tiveram variacao significativa no tempo operatorio (p<0,05), cuja media foi de 57,4(±15,4); 20,8(±10,5) e 39,9(±10,2) minutos, respectivamente. Nao houve variacao quanto a tempo de anestesia (p=0,752), peso dos animais (p=0,524), temperatura retal (p=0,655) e dados da hematimetria preoperatoria (p>0,05). A analise por ELISA de IL-1, TNF-α e IL-10 se mostrou pouco sensivel nas condicoes deste estudo, sendo indetectaveis nas amostras de sangue colhidas nos diferentes tempos. A dosagem de PCR se mostrou factivel, entretanto com grande variabilidade de resultados, o que comprometeu a avaliacao e a comparacao da resposta inflamatoria sistemica nos diferentes grupos por esse marcador. A IL-6 representou a melhor citocina como marcador de resposta inflamatoria sistemica e para analise comparativa entre os grupos. Na analise das dosagens de IL-6, o grupo LPT apresentou niveis sericos da citocina estatisticamente maiores que os demais grupos (P<0,05). Entretanto, nao foi observada diferenca em relacao a IL-6 entre os grupos ANEST, CETON e LPSC, (P>0,49). Conclusoes: Nas presentes condicoes do estudo, peritonioscopia transgastrica diagnostica demonstrou promover impacto minimo sobre os biomarcadores plasmaticos de resposta inflamatoria aguda. O atual modelo experimental se mostrou adequado para o estudo da resposta inflamatoria nas primeiras 24 horas do periodo pos-operatorio
- ItemAcesso aberto (Open Access)Efficacy of syringe-irrigation topical therapy and the influence of the middle turbinate in sinus penetration of solutions(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2017) Wawginiak, Guilherme Henrique; Balsalobre, Leonardo [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Mangussi-Gomes, Joao Paulo [UNIFESP]; Samaniego, Raul Ernesto; Stamm, Aldo CassolIntroduction: Topical therapies are the best postoperative treatment option for chronic rhinosinusitis, especially those with high volume and pressure, such as the squeeze bottles. However, they are not an available option in Brazil, where irrigation syringes are used. Objective: To investigate the efficacy of topical sinonasal therapy with syringe and the influence of the middle turbinate on this process Methods: Intervention study in training models (S.I.M.O.N.T.). After standard dissection, three interventions were performed (Nasal Spray 4 puffs, 60-mL syringe and 240-mL Squeeze Bottle) with normal and Sutured Middle Turbinate. Images of each sinus were captured after the interventions, totalizing 144 images. The images were classified by 10 evaluators according to the amount of residual volume from zero to 3, with zero and 1 being considered poor penetration and 2 and 3, good penetration. The 1440 evaluations were used in this study. Results: Considering all middle turbinate situations, the amount of good penetrations were 8.1% for Spray
- ItemAcesso aberto (Open Access)Quebrando paradigmas na epistaxe grave: a importância de procurar o S-point(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2018) Kosugi, Eduardo Macoto [UNIFESP]; Balsalobre, Leonardo [UNIFESP]; Mangussi-Gomes, Joao [UNIFESP]; Tepedino, Miguel Soares; San-da-Silva, Daniel Marcus [UNIFESP]; Cabernite, Erika Mucciolo; Hermann, Diego; Stamm, Aldo CassolIntroduction: Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. Objective: The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. Methods: A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. Results: Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. Conclusion: The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis. (C) 2018 Associacao Brasileira de Otorrinolaringologia e Cirurgia Cervico-Facial. Published by Elsevier Editora Ltda. This is an open access article under the CC BY license.
- ItemAcesso aberto (Open Access)Redução renal intracorpórea com solução salina hipertônica em suínos submetidos à nefrectomia por portal único e seu impacto na incisão para retirada do órgão(Universidade Federal de São Paulo (UNIFESP), 2018-08-31) Elias, Homar Salim [UNIFESP]; Ribeiro, Cassio Andreoni [UNIFESP]; http://lattes.cnpq.br/2915020488175752; http://lattes.cnpq.br/8901156116967778; Universidade Federal de São Paulo (UNIFESP)Indroduction: Laparoscopic single site surgery has been enthusiastically emerged and the possibility of shrinking organs in order to obtain smaller incisions presents itself as a attractive technical inovation. Objective: To evaluate the feasibility of intracorporeal perfusion with hypertonic saline by laparoscopy using a single port, culminating in a reduction in the length of the surgical incision required for renal extraction. Materials and methods: Experimental study with 20 male pigs weighing about 30 kg, who underwent bilateral videolaparoscopic nephrectomy with a single port. Alternately, on one side the kidney was perfused with 5% saline solution and on the other the kidney was not subjected to any intracorporeal infusion technique. For each nephrectomy, a single permanent trocar was inserted in the ipsilateral axillary line, and the size of the incision required for complete removal of the organ was dimensioned. Renal volumes and time to start and end the procedure were also evaluated. The variables were expressed through the mean ± standard error and analysis of variance model (ANOVA) was adjusted with repeated measures. The level of significance was set at 5%. Results: Six pigs were excluded because of anesthetic and surgical complications. Before the 14 pigs, it was initially found that there was no statistically significant effect of the interaction between side and perfusion, and no statistically significant effect was observed between left and right side. The mean volume of the kidneys with perfusion present, 59.3 ± 2.3 ml, was statistically lower than that obtained in the kidneys with absent perfusion, 74.2 ± 2.2 ml, (p <0.001). The mean of the incision for removal of the kidney when using the infusion was 33.9 ± 0.9 mm, and this was statistically smaller compared to nonperfused, 48.3 ± 0.9 mm, (p <0.001). In another way, the infusion decreased renal volume by 20% and the incision by 30%. The operative time was significantly higher in the perfusion technique, 72.2 ± 6.1 min vs 26.4 ± 6.1 min (p <0.001). Conclusion: The procedure was technically feasible, promoting reduction of the incision, which would allow the amplification of the benefits of minimally invasive surgery in clinical studies.