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CONTEXTO: A correção das hérnias volumosas e dos grandes defeitos da parede abdominal constitui grande desafio da prática cirúrgica, em virtude das dificuldades técnicas e do alto índice de complicações respiratórias e cardiovasculares. OBJETIVOS: Apresentar experiência com a indução do pneumoperitônio progressivo no pré-operatório do tratamento cirúrgico das hérnias volumosas da parede abdominal. MÉTODOS: Estudo retrospectivo de seis pacientes que apresentavam hérnias volumosas da parede abdominal, e que foram operados após a instalação de um pneumoperitônio. O procedimento foi realizado através da colocação de um cateter na cavidade abdominal, na altura do hipocôndrio esquerdo, com insuflação de ar ambiente por período de 10 a 15 dias. RESULTADOS: Dos seis pacientes operados, quatro eram do sexo feminino e dois do masculino. A idade mínima era de 40 e a máxima de 62 anos. A duração da hérnia variou de 5 a 40 anos. Quatro pacientes tinham hérnia incisional, um umbilical e outro inguinal. O tempo médio de pneumoperitônio foi de 11,6 dias. Não houve complicações relacionadas à instalação e manutenção do pneumoperitônio. Todas as hérnias foram corrigidas sem dificuldades técnicas. Utilizou-se a técnica de Lichtenstein para a correção da hérnia inguinal, a transposição peritônio-aponeurótica para uma das hérnias incisionais, sendo as demais corrigidas com uso de tela de polipropileno. Um óbito e uma infecção de parede foram observados no pós-operatório dessas cirurgias. Não houve recidivas registradas até o momento, num período de seguimento de 4 a 36 meses. CONCLUSÃO: O pneumoperitônio progressivo pré-operatório é um procedimento seguro e de fácil execução, pois facilita o procedimento cirúrgico e diminui as complicações respiratórias e cardiovasculares no pós-operatório. É indicado para doentes com hérnias que perderam domicílio na cavidade abdominal. CONTEXT: Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications. OBJECTIVES: To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall. METHODS: Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days. RESULTS: Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up. CONCLUSION: Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.

INTRODUÇÃO: A ruptura gástrica por barotrauma é uma causa rara de abdome agudo perfurativo, sendo geralmente tratada por laparotomia e rafia primária da lesão. Nas reanimações cardiopulmonares pode ocorrer 9 a 12% de lesões de mucosa gástrica. RELATO DO CASO: Mulher no 5º dia de puerpério necessitou intubação orotraqueal devido à pneumonia hospitalar. Após procedimento evoluiu com distensão abdominal importante, associada a sinais de choque séptico. Após radiografia simples de abdome foi constado pneumoperitôneo. Submetida à laparotomia exploradora evidenciou-se ruptura de pequena curvatura gástrica de 7 cm. O tratamento da lesão foi com sutura primária. Recebeu alta no 14º do pós operatório após término do tratamento para pneumonia. CONCLUSÃO: Apesar de rara, a ruptura gástrica por barotrauma deve ser sempre aventada quando após reanimação cardiopulmonar houver distensão abdominal refratária à sondagem naso-gástrica.

Made available in DSpace on 2014-09-30T18:18:26Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-06-01Bitstream added on 2014-10-01T14:03:33Z : No. of bitstreams: 1 S0102-86502014000600394.pdf: 236874 bytes, checksum: 1b3bed4289b63417b8de248815153b8a (MD5) PURPOSE: To analyze the changes in both respiratory function and cardiopulmonary exercise tests results in patients subjected to laparoscopic cholecystectomy. METHODS: Fifty patients were evaluated (76% women) and the average age was 47.8±14.2 years. All individuals underwent the measurement of spirometry, manovacuometry, 6-minute walk test (6MWT) and stair-climbing test (SCT). All tests were performed at the first (PO1), fifth (PO5) and thirtieth (PO30) postoperative days. RESULTS: BMI average was 28.8±4.8 kg/m2. Sample comprised 68% non-smokers, 20% current smokers, and 12% former smokers. There was no incidence of postoperative complication whatsoever. There was a significant decrease in spirometric values at PO1, but values were similar to the ones of PRE at PO30. Manovacuometry showed alterations at PO1 displaying values that were similar to the ones of PRE at PO30. 6MWT was significantly shorter at until PO5, but at PO30 values were similar to ones of PRE. As for SCT, values were significantly compromised at PO5 and PO30 since they were similar to the ones of PRE. CONCLUSION: Patients submitted to laparoscopic cholecystectomy present a decrease in cardiorespiratory function on the first postoperative moments but there is a rapid return to preoperative conditions. Sao Paulo State University Botucatu School of Medicine UNESP Botucatu School of Medicine Sao Paulo State University Botucatu School of Medicine UNESP Botucatu School of Medicine

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:19Z No. of bitstreams: 1 S0102-86502013000400006.pdf: 283506 bytes, checksum: e953aa2a2f604373d02f1abf3fb198e4 (MD5) Made available in DSpace on 2013-08-22T18:58:19Z (GMT). No. of bitstreams: 1 S0102-86502013000400006.pdf: 283506 bytes, checksum: e953aa2a2f604373d02f1abf3fb198e4 (MD5) Previous issue date: 2013-04-01 Made available in DSpace on 2013-09-30T19:53:56Z (GMT). No. of bitstreams: 2 S0102-86502013000400006.pdf: 283506 bytes, checksum: e953aa2a2f604373d02f1abf3fb198e4 (MD5) S0102-86502013000400006.pdf.txt: 25446 bytes, checksum: 8d1bf28d7e2ebb5768d26e200c08549d (MD5) Previous issue date: 2013-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:23Z No. of bitstreams: 2 S0102-86502013000400006.pdf: 283506 bytes, checksum: e953aa2a2f604373d02f1abf3fb198e4 (MD5) S0102-86502013000400006.pdf.txt: 25446 bytes, checksum: 8d1bf28d7e2ebb5768d26e200c08549d (MD5) Made available in DSpace on 2014-05-20T13:32:24Z (GMT). No. of bitstreams: 2 S0102-86502013000400006.pdf: 283506 bytes, checksum: e953aa2a2f604373d02f1abf3fb198e4 (MD5) S0102-86502013000400006.pdf.txt: 25446 bytes, checksum: 8d1bf28d7e2ebb5768d26e200c08549d (MD5) Previous issue date: 2013-04-01 PURPOSE: To evaluate the efficacy of surgical treatment for esophageal perforation. METHODS: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series. RESULTS: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:58:17Z No. of bitstreams: 1 S0102-86502012000300006.pdf: 394714 bytes, checksum: c2a2bacd48ef032ff4471337ac85ca3f (MD5) Made available in DSpace on 2013-08-22T18:58:17Z (GMT). No. of bitstreams: 1 S0102-86502012000300006.pdf: 394714 bytes, checksum: c2a2bacd48ef032ff4471337ac85ca3f (MD5) Previous issue date: 2012-03-01 Made available in DSpace on 2013-09-30T19:53:51Z (GMT). No. of bitstreams: 2 S0102-86502012000300006.pdf: 394714 bytes, checksum: c2a2bacd48ef032ff4471337ac85ca3f (MD5) S0102-86502012000300006.pdf.txt: 41642 bytes, checksum: 69b5a30f0ffe16d942b9c2a100cd1891 (MD5) Previous issue date: 2012-03-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:32:20Z No. of bitstreams: 2 S0102-86502012000300006.pdf: 394714 bytes, checksum: c2a2bacd48ef032ff4471337ac85ca3f (MD5) S0102-86502012000300006.pdf.txt: 41642 bytes, checksum: 69b5a30f0ffe16d942b9c2a100cd1891 (MD5) Made available in DSpace on 2014-05-20T13:32:20Z (GMT). No. of bitstreams: 2 S0102-86502012000300006.pdf: 394714 bytes, checksum: c2a2bacd48ef032ff4471337ac85ca3f (MD5) S0102-86502012000300006.pdf.txt: 41642 bytes, checksum: 69b5a30f0ffe16d942b9c2a100cd1891 (MD5) Previous issue date: 2012-03-01 OBJETIVO: Estudar o efeito do alcoolismo no processo de cicatrização intestinal e suas complicações pós-operatórias em ratos. MÉTODOS: Cento e sessenta ratos foram divididos em dois grupos: tratado e controle. O controle recebeu água, enquanto o tratado etanol a 30%. Após 180 dias foram realizadas colotomia, seguida de anastomose. Após os animais foram divididos em quatro subgrupos de 20 ratos para estudo nos seguintes momentos: 4º, 7º, 14º e 21º pós-operatório. Os parâmetros analisados foram: ganho de peso, força de ruptura, hidroxiprolina tecidual, complicações pós-operatórias e estudo histopatológico. RESULTADOS: O ganho de peso foi superior no grupo controle (p0,05). Houve nove fístulas no grupo tratado, enquanto no controle duas (p0,05). CONCLUSÕES: No grupo tratado ocorreu um processo de subnutrição evidenciado pelo menor ganho de peso. Piora na cicatrização intestinal, indicada pela menor força de ruptura. Ocorreu um maior número de complicações pós-operatórias no grupo tratado. PURPOSE: To study the effect of alcoholism on intestinal healing and postoperative complications in rats METHODS: One hundred and sixty rats were divided into two groups: control and treated. The control group received water and the treated group 30% ethanol. After 180 days, colotomy with anastomosis were performed. After, the groups were divided into four subgroups: 20 rats for study at the following moments: 4th, 7th, 14th and 21st postoperative. The analyzed parameters were: weight gain, breaking strength, tissue hydroxyproline, postoperative complications and histopathological study RESULTS: Weight gain was greater in the control group (p0.05). Nine fistulas occurred in the treated group whereas the control group two (p0.05). CONCLUSIONS: Treated group undergo a malnutrition process that is revealed by lower weight gain. Impaired intestinal healing as indicated by smaller breaking strength. There were a larger number of postoperative complications in the treated animals. UNESP Botucatu School of Medicine Surgery and Orthopedics Department UNESP Botucatu School of Medicine Surgery and Orthopedics Department

Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications.To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall.Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days.Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up.Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:57:39Z No. of bitstreams: 1 S0102-67202007000200001.pdf: 550842 bytes, checksum: 44eeb20be6c7e28b41c3a5af48b23611 (MD5) Made available in DSpace on 2013-08-22T18:57:39Z (GMT). No. of bitstreams: 1 S0102-67202007000200001.pdf: 550842 bytes, checksum: 44eeb20be6c7e28b41c3a5af48b23611 (MD5) Previous issue date: 2007-06-01 Made available in DSpace on 2013-09-30T19:52:38Z (GMT). No. of bitstreams: 2 S0102-67202007000200001.pdf: 550842 bytes, checksum: 44eeb20be6c7e28b41c3a5af48b23611 (MD5) S0102-67202007000200001.pdf.txt: 20848 bytes, checksum: 2557bdb3d2d02477d304361e4e779ba5 (MD5) Previous issue date: 2007-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:13:42Z No. of bitstreams: 2 S0102-67202007000200001.pdf: 550842 bytes, checksum: 44eeb20be6c7e28b41c3a5af48b23611 (MD5) S0102-67202007000200001.pdf.txt: 20848 bytes, checksum: 2557bdb3d2d02477d304361e4e779ba5 (MD5) Made available in DSpace on 2014-05-20T15:13:42Z (GMT). No. of bitstreams: 2 S0102-67202007000200001.pdf: 550842 bytes, checksum: 44eeb20be6c7e28b41c3a5af48b23611 (MD5) S0102-67202007000200001.pdf.txt: 20848 bytes, checksum: 2557bdb3d2d02477d304361e4e779ba5 (MD5) Previous issue date: 2007-06-01 RACIONAL: Dentre as perfurações do trato gastrointestinal, as lesões do esôfago são as de pior prognóstico. OBJETIVO: Avaliar os aspectos etiológicos, diagnósticos e terapêuticos de pacientes com perfuração esofágica atendidos no Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP. MÉTODOS: Avaliação retrospectiva de pacientes internados no período de janeiro de 1999 a dezembro de 2006. Foram estudados 24 pacientes (18 homens e 6 mulheres) com idade média de 52 anos. Os pacientes foram divididos em dois grupos de 12. O Grupo 1 compreendia os pacientes cuja perfuração ocorreu na evolução de câncer do esôfago e o Grupo 2 os pacientes com perfuração devida a causas diversas. No Grupo 2 as causas foram: procedimento endoscópico em três casos, fundoplicatura em três, ingestão de corpo estranho em dois, balão de Blackmore em um, ingestão de antiinflamatório em um, pós-operatório de diverticulectomia em um, ferimento por arma de fogo em um. O esôfago torácico foi o local mais acometido (12 pacientes no Grupo 1 e sete no Grupo 2. em cinco pacientes do Grupo 1 foi realizada entubação transtumoral e nos demais gastrostomia ou jejunostomia. No Grupo 2, o procedimento realizado nas perfurações do esôfago torácico foi esofagectomia. RESULTADOS: A mortalidade operatória no Grupo 1 foi de 25% e no Grupo 2 de 8,33%. Conclusão - a) A lesão do esôfago cervical apresenta, em geral, evolução favorável; b) a conduta cirúrgica, mesmo quando realizado em fase não precoce (primeiras 24 horas), resulta em boa resolução. BACKGROUND:- Among perforations of the gastrointestinal tract, esophageal lesions are of worst prognosis. AIM: To evaluate the etiology, frequency, diagnosis and therapeutic applied in patients with esophageal perforations assisted at the clinical hospital of the Botucatu School of Medicine - UNESP. METHODS: This is a retrospective assessment of patients hospitalized from January 1999 to December 2006. Twenty-four patients (18 males and 6 females) with a mean age of 52 years were studied. Patients were divided into 2 groups of 12 individuals each: Group 1: patients whose perforation occurred during esophageal cancer development, and Group 2: patients with perforation resulting from various causes. In Group 2, the causes were endoscopic procedure (3), fundoplication (3), foreign body ingestion (2), Blackmore balloon (1), anti-inflammatory drug ingestion (1), diverticulectomy postoperative period (1), firearm wound (1). Thoracic esophagus was the most frequently affected site 12 patients in Group 1 and 7 in Group 2. In 5 patients from Group 1, transtumoral intubation was performed, and gastrostomy or jejunostomy was carried out in the others. In Group 2, the procedure adopted for thoracic perforations was esophagectomy. RESULTS: Operative mortality in Group 1 was 25%, and in Group 2 it was of 8.33%. CONCLUSIONS: a) Cervical esophageal lesion generally presents favorable development; b) surgical treatment, even when performed at a non-early phase (first 24 hours) results in good evolution. UNESP Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia UNESP Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:50:24Z No. of bitstreams: 1 S0100-69912007000200016.pdf: 30124 bytes, checksum: 4b073c49865b8a7f23367446c7afe962 (MD5) Made available in DSpace on 2013-08-22T18:50:24Z (GMT). No. of bitstreams: 1 S0100-69912007000200016.pdf: 30124 bytes, checksum: 4b073c49865b8a7f23367446c7afe962 (MD5) Previous issue date: 2007-04-01 Made available in DSpace on 2013-09-30T18:17:59Z (GMT). No. of bitstreams: 2 S0100-69912007000200016.pdf: 30124 bytes, checksum: 4b073c49865b8a7f23367446c7afe962 (MD5) S0100-69912007000200016.pdf.txt: 7223 bytes, checksum: fa8612d2609f075b031810716fc38be7 (MD5) Previous issue date: 2007-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:33:46Z No. of bitstreams: 2 S0100-69912007000200016.pdf: 30124 bytes, checksum: 4b073c49865b8a7f23367446c7afe962 (MD5) S0100-69912007000200016.pdf.txt: 7223 bytes, checksum: fa8612d2609f075b031810716fc38be7 (MD5) Made available in DSpace on 2014-05-20T13:33:46Z (GMT). No. of bitstreams: 2 S0100-69912007000200016.pdf: 30124 bytes, checksum: 4b073c49865b8a7f23367446c7afe962 (MD5) S0100-69912007000200016.pdf.txt: 7223 bytes, checksum: fa8612d2609f075b031810716fc38be7 (MD5) Previous issue date: 2007-04-01 Barogenic rupture of the stomach is a rare complication following cardiopulmonary resuscitation, administration of nasal oxygen by catheter and diving accidents. We report a case of gastric barotrauma following oroesophageal intubation. In most cases, the tears occur along the lesser curvature, what have been already attributed to Laplace's formula and, more recently, to morphological features of the stomach. Faculdade de Medicina de Botucatu Departamento de Cirurgia e Ortopedia UNESP Faculdade de Medicina de Botucatu Hospital das Clínicas UNESP Faculdade de Medicina de Botucatu Hospital das Clínicas