Base de dados : LILACS
Pesquisa : E05.225 [Categoria DeCS]
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Id: biblio-1152633
Autor: Steinbruck, Klaus; Fernandes, Reinaldo; Doliveira, Marcelo; Capelli, Rafaela; Cano, Renato; Vasconcelos, Hanna; Basilio, Luiza; Enne, Marcelo.
Título: External pringle maneuver in laparoscopic liver resection: a safe, cheap and reproducible way to perform it / Manobra de pringle extracorpórea em ressecções hepáticas laparoscópicas: maneira segura, barata e reproduzível de realizá-la
Fonte: ABCD arq. bras. cir. dig;33(4):e1555, 2020. graf.
Idioma: en.
Resumo: ABSTRACT Background: Laparoscopic liver resection is performed worldwide. Hemorrhage is a major complication and bleeding control during hepatotomy is an important concern. Pringle maneuver remains the standard inflow occlusion technique. Aim: Describe an extracorporeal, efficient, fast, cheap and reproducible way to execute the Pringle maneuver in laparoscopic surgery, using a chest tube. Methods: From January 2014 to March 2020, our team performed 398 hepatectomies, 63 by laparoscopy. We systematically encircle the hepatoduodenal ligament and prepare a tourniquet to perform Pringle maneuver. In laparoscopy, we use a 24 Fr chest tube, which is inserted in the abdominal cavity through a small incision. We thread the cotton tape through the tube, pulling it out through the external end, outside the abdomen. To perform the tourniquet, we just need to push the tube as we hold the tape, clamping both with one forceps. Results: The 24 Fr chest tube is firm and works perfectly to occlude blood inflow as the cotton band is tightened. It has an internal diameter of 5,5 mm, sufficient for a laparoscopic grasper pass through it to catch the cotton band, and an external diameter of 8 mm, which allows to be inserted in the abdomen through a tiny incision. The cost of this tube and the cotton band is less than US$ 1. No complications related to the method were identified in our patients. Conclusions: The extracorporeal Pringle maneuver presented here is a safe, cheap and reproducible method, that can be used for bleeding control in laparoscopic liver surgery.

RESUMO Racional: Ressecções hepáticas laparoscópicas são realizadas em todo mundo. A hemorragia é complicação grave e o controle do sangramento durante a hepatotomia é preocupação importante. A manobra de Pringle continua sendo a técnica padrão de oclusão do influxo sanguíneo. Objetivo: Descrever uma maneira eficiente, rápida, barata e reproduzível de executar a manobra de Pringle extracorpórea, em operação laparoscópica, utilizando um dreno de tórax. Métodos: De janeiro/2014 a março/2020, realizamos 398 hepatectomias, 63 por laparoscopia. Nós sistematicamente laçamos o ligamento hepatoduodenal e preparamos um torniquete para a manobra de Pringle. Na laparoscopia, usamos um dreno de tórax 24 Fr, inserido na cavidade abdominal através de uma pequena incisão. Passamos a fita de algodão através do tubo, puxando-a pela extremidade externa, fora do abdome. Para apertar o torniquete, basta pressionar o tubo enquanto seguramos a fita, prendendo ambos com uma pinça. Resultados: O dreno de tórax 24 Fr é firme e funciona perfeitamente para ocluir influxo de sangue, à medida que apertamos o torniquete. Tem diâmetro interno de 5,5 mm, suficiente para passar uma pinça laparoscópica e puxar a fita de algodão, e um diâmetro externo de 8 mm, permitindo a inserção no abdome através de uma pequena incisão. O custo do tubo e fita é inferior a US$ 1, valor insignificante. Não foram identificadas complicações relacionadas ao método em nossos pacientes. Conclusões: A manobra extracorpórea de Pringle apresentada aqui é método seguro, barato e reproduzível, que pode ser utilizado para o controle do sangramento em hepatectomias laparoscópicas.
Descritores: Laparoscopia/métodos
Cavidade Abdominal/diagnóstico por imagem
Hepatectomia/métodos
Neoplasias Hepáticas/cirurgia
-Constrição
Limites: Humanos
Responsável: BR1.1 - BIREME


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Id: biblio-1045704
Autor: Gupta, G; Singa, R; Gupta, S; Gupta, S.
Título: Penile incarceration caused by an axe ring: an unusual case of sexual perversion
Fonte: West Indian med. j;62(6):571-571, July 2013. ilus.
Idioma: en.
Descritores: Transtornos Parafílicos/complicações
Doenças do Pênis/etiologia
Pênis/patologia
Edema/etiologia
-Comportamento Sexual
Constrição
Limites: Humanos
Masculino
Adulto Jovem
Tipo de Publ: Relatos de Casos
Carta
Responsável: BR1.1 - BIREME


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Id: biblio-892939
Autor: Lanchon, Cecilia; Arnoux, Valentin; Fiard, Gaëlle; Descotes, Jean-Luc; Rambeaud, Jean-Jacques; Lefrancq, Jean-Benjamin; Poncet, Delphine; Terrier, Nicolas; Overs, Camille; Franquet, Quentin; Long, Jean-Alexandre.
Título: Super-selective robot-assisted partial nephrectomy using near-infrared flurorescence versus early-unclamping of the renal artery: results of a prospective matched-pair analysis
Fonte: Int. braz. j. urol;44(1):53-62, Jan.-Feb. 2018. tab.
Idioma: en.
Resumo: ABSTRACT Introduction Super-selective clamping of tumor-specific segmental arteries was developed to eliminate ischemia of the remnant kidney while limiting hemorrhage during partial nephrectomy. The objective is to evaluate the benefice of super-selective clamping on renal functional outcome, compared to early-unclamping of the renal artery. Materials and Methods From March 2015 to July 2016, data from 30 patients undergoing super-selective robot-assisted PN (RAPN) for a solitary tumor by a single surgeon were prospectively collected. Tumor devascularization was assessed using indocyanine green near-infrared fluorescence. A matched-pair analysis with a retrospective cohort undergoing early-unclamping was conducted, adjusting on tumor complexity and preoperative eGFR. Perioperative, oncologic and functional outcomes using DMSA-renal scintigraphy were assessed. Multivariate analysis was performed to identify predictors of postoperative renal function and de novo chronic kidney disease (CKD). Results Super-selective RAPN was successful in 23/30 patients (76.7%), 5 requiring secondary main artery clamping due to persistent tumor fluorescence. Matched-pair analysis showed similar operating time, blood loss, positives margins and complication rates. Super-selective clamping was associated with an improved eGFR variation at discharge (p=0.002), 1-month (p=0.01) and 6-month post-op (-2%vs-16% p=0.001). It also led to a better relative function on scintigraphy (46%vs40% p=0.04) and homolateral eGFR (p=0.04), and fewer upstaging to CKD stage ≥3 (p=0.03). On multivariate analysis, super-selective clamping was a predictor of postoperative renal function. Conclusion Super-selective RAPN leads to an improved preservation of renal function and a reduced risk of de novo CKD stage≥3, while keeping the benefit of main artery clamping on perioperative outcomes.
Descritores: Artéria Renal
Procedimentos Cirúrgicos Robóticos/métodos
Isquemia/prevenção & controle
Neoplasias Renais/cirurgia
Neoplasias Renais/irrigação sanguínea
Nefrectomia/métodos
-Cuidados Pós-Operatórios
Estudos Retrospectivos
Resultado do Tratamento
Procedimentos Cirúrgicos Minimamente Invasivos
Constrição
Espectroscopia de Luz Próxima ao Infravermelho
Pessoa de Meia-Idade
Limites: Humanos
Masculino
Feminino
Idoso
Tipo de Publ: Estudo Comparativo
Responsável: BR1.1 - BIREME


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Id: biblio-1019881
Autor: Mazzeo, Angela; Sincos, Anna Paula Weinhardt Baptista; Leite, Katia Ramos Moreira; Góes J, Miguel Angelo; Pavão, Oscar Fernando Santos dos; Kaufmann, Oskar Grau.
Título: Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle
Fonte: Int. braz. j. urol;45(4):754-762, July-Aug. 2019. tab, graf.
Idioma: en.
Resumo: ABSTRACT Purpose This study aimed to study morphological and renal structural changes in relation to different ischemic times and types of renal vascular pedicle clamping. Methods Sixteen pigs were divided into two groups (n = 8): Group AV - unilateral clamping of the renal artery and vein and Group A - unilateral clamping of the renal artery only, both with the contralateral kidney used as control. Serial biopsies were performed at 0, 10, 20, 30, 40, 50, 60, 70, 80, and 90 minutes after clamping. Results there is a correlation between the occurrence of renal damage as a function of time (p <0.001), with a higher frequency of Group A lesions for cellular alterations (vascular congestion and edema, interstitial inflammatory infiltrate, interstitial hemorrhage and cell degeneration), with the exception of in the formation of pigmented cylinders that were evidenced only in the AV Group. Conclusion the number of lesions derived from ischemia is associated with the duration of the insult, there is a significant difference between the types of clamping, and the AV Group presented a lower frequency of injuries than Group A. The safety time found for Group A was 10 minutes and for Group AV 20 minutes.
Descritores: Artéria Renal/patologia
Veias Renais/patologia
Isquemia/patologia
Rim/irrigação sanguínea
Rim/patologia
Nefrectomia/métodos
-Valores de Referência
Suínos
Fatores de Tempo
Biópsia
Reprodutibilidade dos Testes
Constrição
Limites: Animais
Feminino
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: biblio-1040060
Autor: Favorito, Luciano A.
Título: Editorial Comment: Study of kidney morphologic and structural changes related to different ischemia times and types of clamping of the renal vascular pedicle
Fonte: Int. braz. j. urol;45(4):763-764, July-Aug. 2019.
Idioma: en.
Descritores: Isquemia
Rim
-Constrição
Limites: Humanos
Tipo de Publ: Comentário
Editorial
Responsável: BR1.1 - BIREME


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Id: biblio-897909
Autor: Huseyin, Serhat; Guclu, Orkut; Yüksel, Volkan; Erkul, Gulen Sezer Alptekin; Can, Nuray; Turan, Fatma Nesrin; Canbaz, Suat.
Título: Avoiding liver injury with papaverine and ascorbic acid due to infrarenal cross-clamping: an experimental study
Fonte: Rev. bras. cir. cardiovasc = Braz. j. cardiovasc. surg. (impr.);32(3):197-201, May-June 2017. tab, graf.
Idioma: en.
Resumo: Abstract Objective: Ischemia-reperfusion injury after acute ischemia treatment is a serious condition with high mortality and morbidity. Ischemia-reperfusion injury may result in organ failure particularly in kidney, lung, liver, and heart. In our study, we investigated the effects of papaverine and vitamin C on ischemia-reperfusion injury developed in the rat liver after occlusion-reperfusion of rat aorta. Methods: 32 Sprague-Dawley female rats were randomized into four groups (n=8). Ischemia was induced with infrarenal aortic cross-clamping for 60 minutes; then the clamp was removed and reperfusion was allowed for 120 minutes. While the control group and the ischemia-reperfusion group did not receive any supplementary agent, two other groups received vitamin C and papaverine hydrochloride (papaverine HCL). Liver tissues were evaluated under the light microscope. Histopathological examination was assessed by Suzuki's criteria and results were compared between groups. Results: In ischemia-reperfusion group, severe congestion, severe cytoplasmic vacuolization, and parenchymal necrosis over 60% (score 4) were observed. In vitamin C group, mild congestion, mild cytoplasmic vacuolization and parenchymal necrosis below 30% (score 2) were found. In papaverine group, moderate congestion, moderate cytoplasmic vacuolization and parenchymal necrosis below 60% (score 3) were observed. Conclusion: An ischemia of 60 minutes induced on lower extremities causes damaging effects on hepatic tissue. Vitamin C and papaverine are helpful in reducing liver injury after acute ischemia reperfusion and may partially avoid related negative conditions.
Descritores: Papaverina/farmacologia
Ácido Ascórbico/farmacologia
Vasodilatadores/farmacologia
Traumatismo por Reperfusão/prevenção & controle
Fígado/efeitos dos fármacos
Fígado/irrigação sanguínea
Antioxidantes/farmacologia
-Aorta Abdominal
Papaverina/uso terapêutico
Ácido Ascórbico/uso terapêutico
Fatores de Tempo
Traumatismo por Reperfusão/patologia
Distribuição Aleatória
Ratos Sprague-Dawley
Constrição
Modelos Animais de Doenças
Fígado/patologia
Necrose
Antioxidantes/uso terapêutico
Limites: Animais
Feminino
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: biblio-958395
Autor: Mujtaba, Syed Saleem; Ledingham, Simon M; Shah, Asif Raza; Pillay, Thasee; Schueler, Stephan; Clark, Stephen.
Título: Aortic valve replacement with a conventional stented bioprosthesis versus sutureless bioprosthesis: a study of 763 patients
Fonte: Rev. bras. cir. cardiovasc = Braz. j. cardiovasc. surg. (impr.);33(2):122-128, Mar.-Apr. 2018. tab.
Idioma: en.
Resumo: Abstract Objective: The aim of this retrospective study was to compare early postoperative outcomes after aortic valve replacement (AVR) with sutureless bioprostheses and conventional stented bioprostheses implanted through median sternotomy. Methods: From January 2011 to December 2016, 763 patients underwent aortic valve replacement with bioprostheses; of these, 139 received a Perceval S sutureless valve (Group A) and 624 received a Perimount Magna Ease valve (Group B). These groups were further divided into A1 (isolated Perceval AVR), A2 (Perceval AVR with coronary artery bypass grafting [CABG]), B1 (isolated conventional stented bioprosthesis), and B2 (conventional stented bioprosthesis + CABG). Results: Patients in Group A were older (mean 74 years vs. 71 years; P<0.0001), predominantly women (53% vs. 32%; P<0.0001), had a higher logistic EuroSCORE (3.26 vs. 2.43; P<0.001), more preoperative atrial fibrillation (20% vs. 13%; P=0.03), and had a lower reopening rate for bleeding (2.1% vs. 6.7%; P=0.04). Compared to Group B1, Group A1 had shorter cross-clamp (mean 40 min vs. 57 min; P≤0.0001) and bypass times (mean 63 min vs. mean 80 min; P=0.02), and they bled less postoperatively (mean 295 ml vs. mean 393 ml; P=0.002). The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: In our retrospective study of 763 patients, sutureless valve group patients are older, mostly women, more symptomatic preoperatively, and have higher logistic EuroSCORE. They have shorter cross-clamp and bypass times, less postoperative bleeding, and reduced incidence of reopening. Further studies are needed to evaluate the clinical benefits in short, mid, and long-terms.
Descritores: Estenose da Valva Aórtica/cirurgia
Bioprótese/normas
Próteses Valvulares Cardíacas/normas
Substituição da Valva Aórtica Transcateter/métodos
-Valva Aórtica/cirurgia
Período Pós-Operatório
Desenho de Prótese
Fatores de Tempo
Ponte Cardiopulmonar/métodos
Reprodutibilidade dos Testes
Estudos Retrospectivos
Resultado do Tratamento
Constrição
Esternotomia/métodos
Procedimentos Cirúrgicos sem Sutura/métodos
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo Comparativo
Estudo Observacional
Responsável: BR1.1 - BIREME


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Id: biblio-958397
Autor: Mujtaba, Syed Saleem; Ledingham, Simon; Shah, Asif Raza; Schueler, Stephan; Clark, Stephen; Pillay, Thasee.
Título: Thrombocytopenia after aortic valve replacement: comparison between sutureless perceval s valve and perimount magna ease bioprosthesis
Fonte: Rev. bras. cir. cardiovasc = Braz. j. cardiovasc. surg. (impr.);33(2):169-175, Mar.-Apr. 2018. tab.
Idioma: en.
Resumo: Abstract Introduction: The incidence of postoperative thrombocytopenia after aortic valve replacement (AVR) with the Perceval S Sutureless bioprosthesis remains unclear. The aim of this study was to report thrombocytopenia associated with the use of sutureless AVR. Methods: The data was collected retrospectively for patients who had isolated AVR with sutureless Perceval S valve (Group A: 72 patients) and was compared with patients who underwent isolated sutured AVR with Perimount Magna Ease Bioprosthesis (Group B: 101 patients) in our institution between June 2014 and January 2017. Results: Cardiopulmonary bypass and cross-clamp time were significantly shorter in group A. Maximum drop in platelet count was 58% mean (day 2.3) in group A versus 44% mean (day 1.7) in group B (P=0.0001). Absolute platelet count on postoperative day 1-6 in group A was significantly less than in group B (P≤0.05). Platelet count recovered to preoperative value in 44% patients in group B versus only in 26% patients in group A at discharge (P=0.018). Moderate thrombocytopenia occurs more often in group A (41% vs. 26%) (P=0.008) while severe thrombocytopenia (<50 x 109) was observed in 6% in group A but never in group B. Platelets (P=0.007) and packed red blood cells (P=0.009) transfusion was significantly higher in the group A. Conclusion: The implantation of sutureless Perceval aortic valves was associated with a significant drop in platelet count postoperatively with slow recovery and higher platelets and packed red blood cells transfusion requirements. A prospective randomised trial is needed to confirm our findings.
Descritores: Complicações Pós-Operatórias/etiologia
Trombocitopenia/etiologia
Bioprótese/efeitos adversos
Próteses Valvulares Cardíacas/efeitos adversos
Implante de Prótese de Valva Cardíaca/efeitos adversos
-Valva Aórtica/cirurgia
Contagem de Plaquetas
Desenho de Prótese
Fatores de Tempo
Ponte Cardiopulmonar/efeitos adversos
Estudos Retrospectivos
Resultado do Tratamento
Constrição
Implante de Prótese de Valva Cardíaca/métodos
Procedimentos Cirúrgicos sem Sutura/efeitos adversos
Procedimentos Cirúrgicos sem Sutura/métodos
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Idoso de 80 Anos ou mais
Tipo de Publ: Estudo Comparativo
Estudo Observacional
Responsável: BR1.1 - BIREME


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Id: biblio-958400
Autor: Dayan, Victor; Paganini, Juan Jose; Marichal, Alvaro; Brusich, Daniel.
Título: On-Pump beating/non-beating cabg in stable angina have similar outcomes
Fonte: Rev. bras. cir. cardiovasc = Braz. j. cardiovasc. surg. (impr.);33(2):183-188, Mar.-Apr. 2018. tab, graf.
Idioma: en.
Resumo: Abstract Objective: On pump beating/non-beating coronary artery bypass grafts (CABG) has been compared in patients with unstable angina and/or severe left ventricular dysfunction. There is scarce evidence regarding the beneficial use of on-pump beating CABG in patients with stable angina and normal left ventricular function. Our aim was to study the postoperative results using both techniques in this group of patients. Methods: One thousand one hundred and forty-five patients with stable angina underwent on-pump isolated CABG in Uruguay from 2011 to 2015. Patients were grouped into beating/non-beating CABG. Operative mortality and long-term survival were evaluated as primary outcome. Logistic regression analysis was performed to define the predictive role of aortic cross clamp (AXC) on prolonged inotropic support, ventilator support and intraoperative glycemia. Results: Among the included patients, 988 underwent aortic cross clamp. No differences were found in operative mortality, stroke and long-term survival among both groups. Patients without AXC showed higher intraoperative values of glycemia and higher incidence of postoperative prolonged mechanical ventilator support (7.6% vs. 2.4%; P=0.001). The need for prolonged inotropic support was lower in this group of patients (27.4% vs. 49.5%; P<0.001). Conclusion: On-pump beating CABG has similar operative mortality and long-term survival compared with conventional AXC. Higher intraoperative glycemia and higher incidence for prolonged mechanical ventilator is associated with on-pump beating CABG. On the contrary, higher incidence for prolonged inotropic support is associated with AXC. Taking these factors into consideration, both techniques are safe and allow the surgeon to choose the most comfortable option.
Descritores: Ponte Cardiopulmonar/métodos
Ponte de Artéria Coronária/métodos
Disfunção Ventricular Esquerda/cirurgia
Angina Estável/cirurgia
-Fatores de Tempo
Ponte Cardiopulmonar/mortalidade
Modelos Logísticos
Ponte de Artéria Coronária/mortalidade
Análise Multivariada
Reprodutibilidade dos Testes
Estudos Retrospectivos
Fatores de Risco
Função Ventricular Esquerda
Resultado do Tratamento
Disfunção Ventricular Esquerda/mortalidade
Constrição
Estimativa de Kaplan-Meier
Angina Estável/mortalidade
Limites: Humanos
Masculino
Feminino
Pessoa de Meia-Idade
Idoso
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME


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Id: biblio-958409
Autor: Geldi, Onur; Kubat, Emre; Ünal, Celal Selçuk; Canbaz, Suat.
Título: Acetaminophen mitigates myocardial injury induced by lower extremity ischemia-reperfusion in rat model
Fonte: Rev. bras. cir. cardiovasc = Braz. j. cardiovasc. surg. (impr.);33(3):258-264, May-June 2018. tab, graf.
Idioma: en.
Resumo: Abstract Objective: The injury-reducing effect of acetaminophen, an effective analgesic and antipyretic on ischemia-reperfusion continues to attract great attention. This study analyzed the protective effect of acetaminophen on myocardial injury induced by ischemia-reperfusion in an experimental animal model from lower extremity ischemia-reperfusion. Methods: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage. Results: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124). Conclusion: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion.
Descritores: Cardiotônicos/farmacologia
Traumatismo por Reperfusão Miocárdica/prevenção & controle
Extremidade Inferior/irrigação sanguínea
Acetaminofen/farmacologia
-Aorta Abdominal/patologia
Valores de Referência
Fatores de Tempo
Traumatismo por Reperfusão Miocárdica/patologia
Distribuição Aleatória
Ratos Sprague-Dawley
Constrição
Modelos Animais de Doenças
Edema Cardíaco/patologia
Isquemia/prevenção & controle
Isquemia/sangue
Miofibrilas/patologia
Limites: Humanos
Animais
Feminino
Tipo de Publ: Estudo de Avaliação
Responsável: BR1.1 - BIREME



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