Biomedical subjects

H W Pinotti

Publications and source records attributed to H W Pinotti.

268 records · Page 15Linked to original sources

PubMedDate not supplied

[Reconstruction of a thoracic wall defect using a flap of omentum obtained by laparoscopy].

Reconstructive of complex chest wall defects following infected sternotomy represents a surgical challenge. Several options were described for these defects reconstructions, using muscles flaps and omentum which provided obliteration of dead space and coverage. We present a reconstruction of a major chest and abdominal wall defect in a 62-year old patient, who had mediastinitis, osteomyelitis and necrosis of sternum after myocardial revascularization. The pectoralis major was used unsuccessfully, with total loose of the flap. After wound failure, a flap of omentum based on the left gastroepiploic vessels was obtained by a laparoscopic surgery, with no complication. The omentum was translocated through the defect that reached the abdominal wall covering the defect and allowing the use of split-thickness grafts. The laparoscopic procedure showed advantages over the laparotomy in the management of omentum, with the same results in the reconstruction of the defect added the advantages of a minimal invasive procedure, mainly in patient with bad clinical conditions.

Humans↗

PubMedDate not supplied

[Chronic anal fissure: results of the surgical treatment of 220 patients].

Since results from non-surgical procedures designed for treatment of chronic anal fissure are still controversial, sphincterotomy remain as the "state of the art" therapy for this condition. In a retrospective basis, the authors intend to review results from treatment of chronic anal fissure in 220 patients who underwent surgical procedure between 1984 and 1995. Data from chart review included age, sex, location of the lesion at the canal anal, associated anorectal disease, delivered surgical technique and complications. Seventy per cent of the patients were male. Mean age was 37.1 years. Fissure was located at the posterior midline in 86.1%. Associated anorectal conditions occurred in 41.4%. Fissurectomy plus posterior sphincterotomy was the treatment of choice in 84.1%. Complications occurred in 5 (2.3%) cases. There were no incontinent patients. Mean follow-up was 2.6 years. The authors conclude that partial internal anal sphincter section produces excellent results in treatment of chronic anal fissure. Posterior sphincterotomy may persist effective and safe since continence impairment was not identified in the present study.

Adult↗

PubMedDate not supplied

[Laparoscopic repair of chronic traumatic diaphragmatic hernia: case report and review of the literature].

The management of diaphragmatic injury would appear to be a simple matter of suturing the defect. However, preoperative diagnosis can be difficult and even at the time of surgery some diaphragmatic injuries can be overlooked if careful exploration in not done. Associated injuries tend to divert attention from the diaphragmatic injury. Laparoscopic diagnosis and repair have been described with successful.

Adolescent↗

PubMedDate not supplied

[Results of the surgical treatment of non-complicated pilonidal disease].

In spite of the high incidence of pilonidal disease at young population and prolonged disabling period that it demands, colorectal surgeons have not reached consensus about etiology or best treatment for this condition. The authors intend to analyse results from 154 cases operated on at HCFMUSP through a retrospective chart analysis regarding patients' sex, age and race, operative technique, complications and recurrence. Half patients were male. Eighty-three percent were between 11 and 30 yr-old. Incision and curettage was offered to 74.7% of the patients. Excision technique was used in 25.3%. In patients who underwent excision technique, there were no recurrences and a cicatrization defect was diagnosed in 2 (5.1%) patients. For patients who underwent incision and curettage, recurrence was 3.5% and cicatrization defect was seen in 1 (0.9%) case. Excision or incision plus curettage techniques seem to be both effective for treatment of chronic pilonidal disease although the former may produce healing defect more commonly. Patients who present with complex lesions may benefit from excisional techniques associated to skin or myocutaneous flaps in a first attempt instead of conservative approaches.

Adolescent↗

PubMedDate not supplied

[Prevalence of fecal incontinence in diabetic patients: epidemiological study of patients assisted as outpatients at the Clinical Hospital of the Medical School at the University of São Paulo].

The object of this research was to establish the prevalence of fecal incontinence in those diabetics attended as outpatients at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Individual verbal interviewing was the an adopted method. The classification of diabetes mellitus of World Health Organization was employed (1985). Data was aggregated relative sex, age, color, type of diabetes mellitus, fecal incontinence, duration of diabetes mellitus, peripheral neuropathy, intestinal habits (normal, constipation and diarrhea), urgency to evacuate, sensation of incomplete evacuation, urinary incontinence, vaginal deliveries and its characteristics. The study involved 258 diabetics, 167 of female sex having an average age of 56.2 years (17 to 78 years of age) and 91 of the male sex having average age of 55.8 years (10 to 74 years of age). With relation to color, 57% were white, 28.7% mullato, 11.2% black and 3.1% yellow. Fecal incontinence was prevalent in 18.6% of the cases studied. It occurred also in types I and II diabetics with predominance in the male sex. It also occurred in diabetics having an average history of 10.8 years to onset of illness. Peripheral neuropathy was observed in 8.5% of the diabetics investigated however no association was observed between the peripheral neuropathy and fecal incontinence. Constipation occurred in 29.5% of the patients and diarrhea in 21.3%. Incomplete evacuation was apparent in 15.1% of diabetics and urgency to evacuate in 12.8%. A relationship was identified between fecal incontinence with diarrhea and incomplete evacuation in the group investigated. Total vaginal deliveries was 458 with 70 episiotomies and 25 by forceps. There was no statistical evidence of association between the average number of vaginal deliveries, episiotomies and forceps in diabetics demonstrating or not demonstrating fecal incontinence. Urinary incontinence was more prevalent that fecal incontinence. No relationship was determined between urinary and fecal incontinence for the purpose of the present study.

Adolescent↗

PubMedDate not supplied

[Videolaparoscopic treatment of hepatic single cysts].

We report a study of 6 patients with simple hepatic cyst. All were underwent laparoscopic surgical treatment. The median age of patients was 66 years, 5 women and 1 man were in the series. Cyst diameters varied from 3 to 15 cm. The treatment of choice is laparoscopic fenestration and resection of external part. There were no complications in postoperative period and the follow-up results are encouraging.

Aged↗

PubMedDate not supplied

[Duodenal duplication in adult simulating pancreas pseudocyst].

An adult patient with clinical and radiologic evidence of pancreas pseudocyst was undergone at laparotomy and a diagnosis of duodenal duplication was made. Due to the rarity of this case, a review of the literature is presented and the authors discuss the treatment of duodenal duplication.

Adult↗

PubMedDate not supplied

[Hyperdynamic circulation in Manson's hepatosplenic schistosomiasis].

Twenty two patients having indication for surgical treatment of portal hypertension due to hepatoesplenic schistosomiasis were prospectively studied. Each patient was submitted to preoperative monitoring with pulmonary artery catheterization. The results showed hemodynamic alterations characterized by an increase of cardiac index (4.50 +/- 0.96 l/min/m2) associated to a decrease of systemic vascular resistance index (1638.60 +/- 441.86 dyn.s/cm5.m2). The stroke index and all right and left cardiac work indeces were increased. The pulmonary artery mean pressure was increased (17.23 +/- 8.63 mmHg) and the pulmonary vascular resistance index was decreased (147.95 +/- 126.21 dinas.seg/cm5.m2). We concluded that hepatoesplenic schistosomiasis determines hyperdynamic systemic circulation, probably correlated with portosystemic shunt, and pulmonary hypertension.

Adult↗

PubMedDate not supplied

[Carcinoid tumors of the common bile duct: report of a case].

The authors discuss an uncommon case in the literature of a carcinoid tumor of in the bifurcation of common hepatic duct. The tumor was surgically resected and the duct was reconstructed by Y of Roux's technic. The patient had a good evolution and no tumoral lesion was found in post operative exams during the last six months. The authors present a literature review and discuss diagnosis, treatment and prognosis.

Anastomosis, Roux-en-Y↗

PubMedDate not supplied

[Colonic Crohn's disease: results of treatment].

Sixty patients with Crohn's colitis were separated into 2 groups: A) without perianal lesions, 12 patients; B) with perianal lesions, 48 patients. The mean age at the beginning of symptomatology was 41.4 years in group A and 31.7 in B. The number of patients that underwent surgical treatment were similar in both groups. Fifty eight operations were performed in 29 patients, mean 0.33 operations/patient in group A and 2.16 in B. Ileal pouch anal anastomosis were performed in 5 patients, with loss of reservoir in one. There was no difference in need of hospitalization between the 2 groups. At mean follow-up of 8.9 years, 37 patients presented at least one extra-intestinal manifestation, 21 a perianal lesion, 39 were taking drugs and 31 were symptomatic. In the group of 31 patients that received only medical treatment, 24 (77.4%) are still on drugs and only 9 are assymptomatic. In the group of 29 patients that were operated on, 12 (41.4%) are taking drugs and 19 (65.5%) are assymptomatic. The difference concerning results of treatment between patients on medical treatment and operated were statistically significant. A permanent ileostomy was performed in 19(65.5%) patients. Two patients died during clinical treatment and one of postoperative complications.

Adult↗

PubMedDate not supplied

[Esophageal intubation for palliative treatment in advanced carcinoma of the esophagus and cardia].

This is a report of 121 cases of advanced esophageal and cardia cancer managed by endoscopic and surgical esophageal intubation. They were submitted to surgical intubation 69 (53%) patients, and 52 (47%) to endoscopic intubation. There were 32.5% of technical complications in endoscopic intubation and 26.5% in surgical intubation. Perfuration was more frequent (11.5%) in endoscopic intubation than surgical group. Mortality rate was 17.3% for endoscopic and 5.8% for surgical intubation. Perfuration was the main cause of death in endoscopic intubation. Survival rate was 3.5 months for endoscopic and 4.7 months for surgical intubation. The majority of patients died of cancer evolution--caquexia (55.5%), carcinomatosis (4.5%) and brain methastasis (1.1%). The results of endoscopic and surgical intubation in this group of patients recommend its use in patients with advanced esophageal and cardic cancer.

Adenocarcinoma↗

PubMedDate not supplied

[Colonoscopy: indications, contraindications and complications].

The bioengeneering technological development associated with new medical information transformed colonscopy today in one of the most complete method of investigation on colorrectal diseases. The authors aim to describe the use of colonoscopy as a diagnostic and therapeutic method, its main indications and limitations. The wide utilization of colonoscopy as therapy is emphasized in the polipectomy, the identification of bleeding areas and the hemostasy. Some intervening facts are discussed as copious bleeding, perfuration and post polipectomy syndrome. Finally, the authors report the low morbidity and mortality rates in their personal experience with colonoscopy during the last decade.

Colonoscopy↗

PubMedDate not supplied

Surgical treatment of cicatricial biliary strictures.

BACKGROUND/AIMS: Cicatricial biliary strictures are usually associated with high morbidity and mortality rates, frequently related to technical difficulties of their surgical repair, mainly in hilar lesions. Interference with bile duct blood supply during surgical attempts for correction is a major factor for unsuccessful results. The aim of this study is to evaluate, after an extended follow-up period, the results obtained with a modified technique for surgical correction of cicatricial biliary strictures. METHODOLOGY: The medical records of 57 patients surgically treated for cicatricial biliary strictures between January 1984 and July 1995 were reviewed and the immediate and long term results retrospectively analyzed. Patients consisted of 46 females and 11 males. The average age was 43 years. The etiology of the biliary lesion was: cholecystectomy alone (23); cholecystectomy with duct exploration (8); T tube CBD drainage (6); Biliary-enteric anastomosis stricture (16); choledochoplasty (2) and trauma (2). In 28 cases (49.1%) the stricture was located in the upper third of the bile duct, in 28 (49.1%) in the middle third and in one case (1.7%) it was low. All patients were submitted to longitudinal Roux-en-Y hepaticojejunostomy with mucosa apposition after dissection of the anterior aspect of the biliary tract. No transanastomotic stents were used. RESULTS: Ten patients (17.5%) presented 11 postoperative complications: biliary fistula (4), duodenal fistula (1), wound infection (5), and acute pancreatitis (1). Average hospital stay was 11 days and there were no postoperative mortalities. The follow-up study was possible in 54 patients and ranged from one to ten years, with an average of 2.9 years. Four patients of 28 (14%) with hilar lesions developed stricture recurrence and cholangitis episodes, whereas no patients bearing lesions below the biliary junction had such complications. CONCLUSION: Roux-en-Y hepaticojejunostomy with mucosa apposition without transanastomotic stent performed after minimal dissection of the biliary duct, thus avoiding major interference with the bile duct blood supply, is a safe and efficient method for the surgical repair of cicatricial biliary strictures. Using this technique excellent results can be obtained in the lesions below the biliary junction and acceptable results may be achieved in patients with hilar lesions.

Adult↗

PubMedDate not supplied

[Villous and tubulovillous adenomas of the colon and rectum. Results in 30 patients].

UNLABELLED: Colorectal adenomas precede carcinomas as much as they become larger and present villous histology. Since colonoscopic polypectomy cannot remove all polyps, surgical options include local resection as well as segmental colectomy. Significant morbidity and high recurrence rates may occur following individual and polyp-related characteristics. This paper focuses the clinical aspects of colorectal tubulo-villous adenomas and the results of the surgical treatment. PATIENTS AND METHODS: Hospital charts from 30 patients who underwent surgical treatment of colorectal tubulovillous adenomas between 1980 and 1997 were retrospectively reviewed. RESULTS: Rectal bleeding, urgency and mucus discharge were the most frequent clinical findings. Proctologic examination (digital and rigid rectosigmoidoscopy) diagnosed the lesion for the majority of cases. Seventy per cent of the polyps were in the distal rectum and 60% were larger than 4 cm. Transanal resection was the surgical option for one half of the patients and segmental colectomy for the other. Fourty-two per cent of the polyps that were considered benign as result of preoperative biopsy showed malignant transformation when the whole polyp was examined. Recurrence rate was 26.7% and 6.7% for patients who underwent local resection and segmental colectomy respectively. Postoperative complication rate was similar for the two surgical groups. CONCLUSIONS: Recurrence may occur frequently after standard local resection. Preoperative biopsy examination has no role for the diagnosis of malignant transformation. Office proctologic examination diagnoses majority of colorectal polyps that may be elected for surgical resection.

Adenoma, Villous↗

PubMedDate not supplied

[Antioxidative effect of N2-mercaptopropionylglycine (N2 MPG) in experimental acute pancreatitis].

The N2-Mercaptopropionylglycine (N2-MPG) is a potent antioxidant by inhibiting the abnormal production of xantina-oxidase. The aim of this research is to analyze the antioxidant capacity of this tiol compound by offering some protection to pancreatic tissue in the acute pancreatitis (AP). The induction of AP was obtained through two methods: a) supramaximal dose of cerulein; b) infusion of 2.5% sodium taurocholate into the biliopancreatic duct of the rat. Thirty-six male Wistar rats (220-270 g) were divided into four groups. AP with cerulein (Two parenteral doses of 20 micrograms/kg; one hour interval): in two groups: GI: nineteen rats previously treated with N2-MPG (100 mg/kg) ten minutes before AP. GII (control): seventeen animals which received saline 0.9%. AP with taurocholate (0.5 ml into the main biliopancreatic duct): in other two groups: GIII: eleven rats previously treated with N2-MPG (100 mg/kg) ten minutes before AP. GIV (control): fifteen animals which received saline 0.9%. The albumin leakage into the cell interstice as an inflammatory parameter was measured through Evans-Blue (EB) colorimetry, that links totally with serum albumin after injection into the pancreatic tissue, immediately before induction of AP. The rats were sacrificed one hour after. Water tissue content was also measured. There was a relevant reduction of EB leakage in GI (344 +/- 27 micrograms/gtissue) when compared to GII (729 +/- 84 micrograms/gtissue), p < 0.01, and in GIII (386 +/- 52 micrograms/gtissue) when compared to GIV (543 +/- 53 micrograms/gtissue), p < 0.05. There was no difference in tissue water content between GI (88.2 +/- 0.6%) and GII (87.4 +/- 0.9%), but certainly between GIII (77.7 +/- 2.1%) and GIV (82.8 +/- 1.2%), p < 0.05. The amilase levels didn't show any difference among the four groups. These results suggest that the use of the antioxidant N2-MPG offers a protective action, at least in rats, reducing the severity of AP induced by supramaximal dose of cerulein, and even in a more severe AP such as produced by sodium taurocholate at 2.5%, although apparently not interfering with its pathogenesis. It also strengthens the actual participation of free radicals of oxygen in the physiopathology of acute pancreatitis.

Acute Disease↗

PubMedDate not supplied

[Acute appendicitis following laparoscopic inguinal hernioplasty. Coincidence or complication?].

Intraperitoneal complications related to laparoscopic inguinal hernia repair by transabdominal approach had been described. The authors report the first case of postoperative acute appendicitis in a patient submitted to a transuretral prostate resection and bilateral inguinal hernioplasty by the TAPP technique, resulting in a second laparoscopic intervention.

Acute Disease↗