Mariana Jorge Garcia

Analysis of Laser Lipolysis Effects on Human Tissue Samples Obtained from Liposuction

BackgroundThe use of the neodymium: yttrium-aluminum-garnet (Nd:YAG) laser as an auxiliary tool for lipoplasty has refined the traditional technique. The primary limitation of the traditional technique—large volume blood loss—is addressed by the use of the Nd:YAG laser. This report describe’s the technique of laser- assisted liposuction, then reviews and compares the histologic and morphometric effects with those of the traditional method.MethodsThe Nd:YAG laser was used to produce the desired injury to the adipose tissue after sufficient contact. Laser lipolysis was performed on the patient’s right flank in two different areas, with the application of 1,000 and 3,000 J of accumulated energy (∈), respectively. Subsequently, another cannula was introduced to suction the liquid content obtained by laser lipolysis. This tissue product was sent to the pathology laboratory for morphologic and morphometric analysis, and for comparison with material obtained from traditional lipoplasty performed on the left flank of the same patient.Results The histopathologica examination of adipose tissue after laser lipolysis showed cell swelling and less bleeding, as compared with the traditional method. The morphometric analysis showed that the mean diameter of the major adipocye was 95.69 μm with laser lipolysis using 1,000 J (∈), 82.63 μm using 3,000 J (∈), and 84.54 μm with the traditional methodConclusions The traditional method produced less reversible cellular damage (swelling) than laser lipolysis using 1,000 J (∈). The area receiving 3,000 J (∈) showed major irreversible damage (cytoplasmatic retraction and disruption of membranes). For this reason, the mean diameter of the adipocyte was less.

Estudo das atipias indeterminadas em relação à prevalência e ao percentual de discordância nos casos do Programa de Prevenção do Câncer Uterino do Paraná

BACKGROUND: The Bethesda Pap Smear System introduced two categories of undetermined atypias: atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells of undetermined significance (AGUS). The objective of this study is to report the prevalence and the disagreement percentile of ASCUS and AGUS as diagnosed by the Cervical Cancer Screening Program of Parana and revised by the Unit for External Monitoring of Cytology Quality (UEMCQ). METHODS: The UEMCQ revised 65,753 cervical smears during 25 months and all undetermined atypias were selected. These cases were classified according to their agreement or not and then prevalence was obtained. RESULTS: Before the UEMCQ review, the number of undetermined atypias was 4,067 (5.45%); this number decreased to 3,584 after revising the data. Considering the whole sample, the ASCUS rate was 4.91% (3,235) and AGUS corresponded to only 0.51% (338). Most of the reclassified cases presented negative diagnoses (57.32%). The primary grouped diagnoses, including CIN I and HPV, was responsible for 51.1% of undetermined atypias after reclassification. DISCUSSION AND CONCLUSION: Undetermined atypias were the second most frequent among disagreement diagnosis groups.

Hand-assisted right laparoscopic live donor nephrectomy

PURPOSE Laparoscopic live donor nephrectomy has acquired an important role in the era of minimally invasive surgery. Laparoscopic harvesting of the right kidney is technically more challenging than that of the left kidney because of the short right renal vein and the need to retract the liver away from the right kidney. The aim of this article is to report our experience with right laparoscopic live donor nephrectomies. MATERIALS AND METHODS We performed a retrospective review of 28 patients who underwent right laparoscopic donor nephrectomies at our service. Operative data and postoperative outcomes were collected, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy and complications. RESULTS The procedure was performed successfully in all 28 patients. The mean operative time was 83.8 minutes (range 45 to 180 minutes), with an estimated blood loss of 111.4 mL (range 40 to 350 mL) and warm ischemia time of 3 minutes (range 1.5 to 8 minutes). No donor needed conversion to open surgery and all kidneys showed immediate function after implantation. The average time to initial fluid intake was 12 hours (range 8 to 24 hours). Two cases of postoperative ileus and a case of hematoma on the hand-port site were observed. The mean postoperative hospital stay was 3 days (range 1 to 7 days). CONCLUSIONS Our data confirm the safety and feasibility of right laparoscopic donor nephrectomy and we believe that the right kidney should not be avoided for laparoscopic donor nephrectomy when indicated.

Fatores prognósticos em pacientes submetidos à cirurgia por trauma pancreático

OBJETIVO: As lesoes traumaticas pancreaticas sao pouco frequentes apos trauma abdominal fechado ou penetrante. O objetivo deste estudo retrospectivo e analisar a experiencia de um servico universitario e relatar os fatores prognosticos e o tratamento cirurgico instituido. METODO: Foram selecionados e revisados os prontuarios dos pacientes portadores de trauma pancreatico durante um periodo de nove anos em um hospital universitario nivel terciario de trauma e os parâmetros analisados foram: mecanismo do trauma, presenca de choque na admissao, grau da lesao pancreatica, escore de trauma, tratamento cirurgico, complicacoes e mortalidade. RESULTADOS: Oitenta e nove pacientes foram identificados e o diagnostico foi realizado durante a laparotomia em todos os casos. Os traumas abdominais penetrantes foram responsaveis por 67,4% dos casos. Utilizando a Escala de Lesoes de Orgaos, as lesoes grau II e III foram as mais comuns e o tratamento foi definido de acordo com o grau e o local da lesao. A mortalidade global foi de 21,3% e significativamente maior nos pacientes que apresentaram choque na admissao, lesoes pancreaticas grau IV e V, e Escore de Gravidade da Lesao (ISS) elevado. CONCLUSOES: A lesao pancreatica e um fenomeno raro, porem com elevada mortalidade, que esta intimamente relacionada a presenca de choque na admissao, ao grau da lesao pancreatica e ao escore de trauma.

Curva de aprendizado na fundoplicatura laparoscópica durante a residência médica em cirurgia geral

OBJETIVO: A fundoplicatura laparoscopica a 360o e o tratamento de escolha para pacientes com doenca do refluxo gastroesofagico que nao respondem bem ao tratamento clinico. Este artigo demonstra a curva de aprendizado durante a Residencia Medica em Cirurgia Geral. METODO: Foi realizada uma analise retrospectiva de 60 pacientes submetidos a fundoplicatura laparoscopica durante o periodo de marco a outubro de 2005. Os pacientes foram divididos em dois grupos: 30 casos iniciais que foram comparados aos 30 casos subsequentes. As variaveis analisadas incluiram: tempo operatorio, taxa de conversao, complicacoes e tempo de hospitalizacao. RESULTADOS: A fundoplicatura laparoscopica foi realizada em 18 homens e 42 mulheres, com idade media de 48,3 anos. Comparando os dois grupos, houve diferenca estatisticamente significativa no tempo operatorio total (92,7 vs. 76,7 minutos, p=0,003), no tempo operatorio para a operacao de Nissen-Rossetti (86,7 vs. 68,4 minutos, p=0,00006) e no tempo para a liberacao dos vasos gastricos curtos (22 vs. 13,1 minutos, p=0,00005). As complicacoes intra-operatorias foram maiores no primeiro grupo de pacientes, mas a diferenca nao foi estatisticamente significativa (p=0,2). Todos os procedimentos foram concluidos com sucesso por video-laparoscopia em ambos os grupos, e a mortalidade foi nula nesta serie. A alta hospitalar ocorreu em media no primeiro dia de pos-operatorio em ambos os grupos (p=0,06). CONCLUSAO: A fundoplicatura laparoscopica pode ser realizada com seguranca por um cirurgiao em formacao, sob supervisao direta de um titular, com minima morbidade para os pacientes. A curva de aprendizado foi demonstrada, avaliando-se principalmente, o tempo operatorio do procedimento.

Controle dos vasos renais usando clips vasculares e fio cirúrgico em nefrectomias vídeo-assistidas de doadores vivos

BACKGROUND: Laparoscopic live donor nephrectomy has acquired an important role in the minimally invasive surgery era, decreasing morbidity to kidney donors, with an equivalent renal graft outcome compared with open surgery. The aim of this article is report our experience using the technique of renal vessels control with metallic clips and cotton suture. METHODS: Fourty-five nephrectomies were performed following the hand-assisted technique and using titanium clips (LT-300) and cotton suture for renal vessels ligatures. Operative data and postoperative courses were reviewed, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy, and complications. RESULTS: The procedure was performed successfully in all cases, including 18 right nephrectomies and 27 left nephrectomies. The mean operative time in our series was 118 minutes, with an estimated blood loss of 84ml and warm ischemia time of 4.3 minutes. Two cases of postoperative ileus, one gonadal vein lesion, one metallic clip displacement and one ureteral necrosis were observed. The mean postoperative hospital stay was 3.7 days. The use of titanium clips and cotton suture reduced the loss of venous tissue compared to the technique using the Endo-GIA stapling device (4 to 6 mm vs. 10 to 15 mm) and showed to be associated with a cost reduction, saving about 700 US dollars per stapler. CONCLUSION: Hand-assisted nephrectomy using the above described technique is technically feasible and showed to be effective in reducing costs and decreasing the loss of vascular length.

Nevo melanocítico associado à hiperplasia siringofibroadenomatóide: relato de caso

The aim of this study was to report a case of a verrucous lesion diagnosed as a compound melanocytic nevus associated with syringofibroadenomatous hyperplasia. The patient was submitted to excision of the abdominal skin lesion and diagnosed as Miesher melanocytic nevus. Optical microscopy revealed epidermal hyperplasia and dermis with nests of nevus cells intimately associated with eccrine duct clusters arranged in a syringoid pattern. The coexistence of epidermal hyperplasia and syringomatoid proliferation is defined as eccrine syringofibroadenomatosis and may result from growth factors released by the impaired stroma.

Análises morfométrica e morfológica das alterações cutâneas após uso do laser Nd-YAG em tecidos palpebrais humanos

The use of laser Neodymium-Yttrium-Aluminium-Garnet (Nd-YAG) as an auxiliary tool on rejuvenation provided a refining of the traditional technique. This laser procedure show satisfactory results with technical improvement and postoperatory recovery. OBJECTIVES: The aim of this study is to show the histological and morphometrical changes found in human eyelid tissue after the use of laser Nd-YAG and its comparision to the normal structure. MATERIAL AND METHODS: Nine female patients underwent laser Nd-YAG application on their right eyelid. The left eyelid was taken by control-tissue, free of any kind of procedure. It was made many applications of the laser and on the last day, it was made a bilateral biopsy. The morphometrical criteria appraised were: epidermal denseness measure, subepidermal area free of injury, colagen degeneration and total dermal density. RESULTS: In those areas whose underwent laser the epidermal measure was of 33,53 micrometers (µm) and on the normal tissue, was of 29.61µm (p = 0.1099). The subepidermal measure was, on average, of 40.93µm on right side and of 36.27µm on left side (p = 0.1373). The colagen degeneration measure on the right side was of 293.54µm and on the left side was of 292.22µm (p = 0.4835). On the procedure site, the total dermal measure was of 681,48µm and on the free site, it was of 664.14µm (p = 0.3492). DISCUSSION AND CONCLUSIONS: Despite the clinical changes observed after laser Nd-YAG therapy, there were neither histological nor morphometrical significative changes.