Nelson Bergonse Neto

Bloqueio por clipagem de gânglios simpáticos torácicos no tratamento da hiper-hidrose

BACKGROUND: Videothoracoscopic for the treatment of hyperhidrosis is carried out by clamping of the sympathetic trunk, with a possibility for reversal in cases of intense compensatory sweating. OBJECTIVE: To evaluate therapeutic success, satisfaction, and compensatory sweating in patients submitted to this technique. METHOD: Prospective study in which 45 patients were divided into two groups. Group I: one patient with palmar hyperhidrosis and 20 patients with palmar and plantar hyperhidrosis submitted to a T3 block; Group II: four patients with axillary hyperhidrosis, two with axillary and palmar hyperhidrosis, two with axillary and plantar hyperhidrosis, and 16 with axillary, palmar, and plantar hyperhidrosis submitted to a block of T3 and T4. RESULTS: In Group I, 95.2% of the patients had palmar and plantar hyperhidrosis, and in Group II, 66.7% had axillary, palmar, and plantar hyperhidrosis. For the palmar region, excellent or good results occurred in 95.3% of Group I and in 94.4% of Group II; in the plantar region, 40% of Group I and 44.5% of Group II presented good results; in the axillary region, 95.8% reported excellent or good results. In six months, 76.2% of Group I and 91.7% of Group II had experienced compensatory sweating, but intense compensatory sweating occurred in only three patients of Group II. CONCLUSIONS: This treatment proved to be effective for the treatment of hyperhidrosis. At the end of six months, all patients from Group I and 95.9% of the patients from Group II were satisfied with the results.

Pectus Excavatum / Pectus Carinatum: tratamento cirúrgico

BACKGROUND: The authors present the results obtained with one technique for Pectus Carinatum and Pectus Excavatum treatment. METHODS: From 1976 to 2000, 183 patients with chest wall deformities underwent surgery at the Hospital Universitario Cajuru of the Catholic University of Parana. Nighty eight were pectus carinatum (70 symmetric pectus carinatum, 18 lateral pectus carinatum to the right and 10 lateral pectus excavatum to the left), 62 were pectus excavatum (57 symmetric pectus excavatum, four lateral pectus excavatum to the right and one lateral pectus excavatum to the left), 17 were pouter pigeon, one was pectus carinatum with pectus excavatum, four were inferior costal protusions and one costal depression. The indication was exclusively aesthetical in 182 (99,4%) of the patients. For both pectus carinatum and pectus excavatum only one technique was used: inframammary transversal incision, subperichondral ressection of all cartilages involved in the deformity, minimal retrosternal dissection, anterior sternal osteotomy, fastening of the sternal osteotomy with a steel wire. A retrosternal plate can be used in selected Pectus Excavatum cases, folding of the perichondrial bundles to give more rigidity to the thoracic wall and to help keep the sternum in its position, drainage of the subcutaneous cellular tissue and of the submuscular space, intradermal suture of the skin. RESULTS: A good and / or excellent aesthetic result was obtained in 175 (95,6%) of the patients. Complication occurred in 14 (7,6%) patients: eight (4,5%) seroma cases, one (0,5%) hematoma of the chest wall, two( 91,0%) cases of severe chest pain in the post-operative period; one (0,5%) case of dehiscence of skin suture and two cases (1,0%) of hyperthrophic scar, which were treated with ressection and betatherapy. CONCLUSION: The aesthetic results obtained allow us indicate the sternochondroplasty for treatment of Pectus Carinatum and Pectus Excavatum.

Regeneration of Tracheal Tissue in Partial Defects Using Porcine Small Intestinal Submucosa

Background Surgical correction of tracheal defects is a complex procedure when the gold standard treatment with primary end-to-end anastomosis is not possible. An alternative treatment may be the use of porcine small intestinal submucosa (SIS). It has been used as graft material for bioengineering applications and to promote tissue regeneration. The aim of this study was to evaluate whether SIS grafts improved tracheal tissue regeneration in a rabbit model of experimental tracheostomy. Methods Sixteen rabbits were randomized into two groups. Animals in the control group underwent only surgical tracheostomy, while animals in the SIS group underwent surgical tracheostomy with an SIS graft covering the defect. We examined tissues at the site of tracheostomy 60 days after surgery using histological analysis with hematoxylin and eosin (H&E) staining and analyzed the perimeter and area of the defect with Image-Pro® PLUS 4.5 (Media Cybernetics). Results The average perimeter and area of the defects were smaller by 15.3% (p = 0.034) and 21.8% (p = 0.151), respectively, in the SIS group than in the control group. Histological analysis revealed immature cartilage, pseudostratified ciliated epithelium, and connective tissue in 54.5% (p = 0.018) of the SIS group, while no cartilaginous regeneration was observed in the control group. Conclusions Although tracheal SIS engraftment could not prevent stenosis in a rabbit model of tracheal injury, it produced some remarkable changes, efficiently facilitating neovascularization, reepithelialization, and neoformation of immature cartilage.

Modelo mecânico para simulação do condicionamento pulmonar do ar respirado

OBJECTIVE: To create a mechanical model that could be regulated to simulate the conditioning of inspired and expired air with the same normal values of temperature, pressure, and relative humidity as those of the respiratory system of a healthy young man on mechanical ventilation. METHODS: Using several types of materials, a mechanical device was built and regulated using normal values of vital capacity, tidal volume, maximal inspiratory pressure, positive end-expiratory pressure, and gas temperature in the system. The device was submitted to mechanical ventilation for a period of 29.8 min. The changes in the temperature of the air circulating in the system were recorded every two seconds. RESULTS: The statistical analysis of the data collected revealed that the device was approximately as efficient in the conditioning of air as is the respiratory system of a human being. CONCLUSION: By the study endpoint, we had developed a mechanical device capable of simulating the conditioning of air in the respiratory tract. The device mimics the conditions of temperature, pressure, and relative humidity seen in the respiratory system of healthy individuals.OBJECTIVE To create a mechanical model that could be regulated to simulate the conditioning of inspired and expired air with the same normal values of temperature, pressure, and relative humidity as those of the respiratory system of a healthy young man on mechanical ventilation. METHODS Using several types of materials, a mechanical device was built and regulated using normal values of vital capacity, tidal volume, maximal inspiratory pressure, positive end-expiratory pressure, and gas temperature in the system. The device was submitted to mechanical ventilation for a period of 29.8 min. The changes in the temperature of the air circulating in the system were recorded every two seconds. RESULTS The statistical analysis of the data collected revealed that the device was approximately as efficient in the conditioning of air as is the respiratory system of a human being. CONCLUSION By the study endpoint, we had developed a mechanical device capable of simulating the conditioning of air in the respiratory tract. The device mimics the conditions of temperature, pressure, and relative humidity seen in the respiratory system of healthy individuals.

Colecistectomia videolaparoscópica em paciente submetido a transplante cardíaco

Cardiac transplant has been performed with an increased frequency as the treatment for end-stage cardiac disease. Although cholelithiasis is more frequent in both pretransplant and posttransplant patients, no standard management approach exists. Pretransplant patients are well recognized for cardiac events, and posttransplant immunossupressed patients are at a considerable risk for septic complications. Because the first presentation of gallstones in this population is often acute cholecystitis, asymptomatic calculi cannot be considered benign and it seems reasonable to recommend pretransplant screening and posttransplant surveillance for gallstones. Prophylatic laparoscopic cholecistectomy should be undertaken in the stable patient to avoid the substantial mortality associated with postoperative acute cholecystitis and urgent cholecystectomy. In this case report we present a 44 year-old male with acute cholecystitis after cardiac transplantation who was submitted to a safe laparoscopic cholecystectomy one year and seven months later.