Este trabalho tem por objetivo comparar a eficácia da cola biológica de fibrina e da drenagem de aspiração pós-operatória na prevenção de complicações cirúrgicas como hematoma e seroma após a realização de ritidoplastia pela equipe da Clínica Rezende no Hospital Moinhos de Vento, na cidade de Porto Alegre/RS. Realizou-se estudo prospectivo, controlado, randomizado e duplo cego. Foram analisadas 72 pacientes, divididas em dois grupos de 36, sendo que no grupo dreno utilizou-se drenagem de aspiração e no grupo cola utilizou-se cola de fibrina. Quarenta e oito horas após a realização dos procedimentos, todas as pacientes foram submetidas a aferição ecográfica da lâmina de exsudato presente sob os retalhos cutâneos da face. O volume total médio foi de 3,21 mL no grupo dreno e 1,02 mL no grupo cola, com magnitude de efeito de 68,1% e intervalo de confiança de 55,3 a 77,2 e p <0,001. Com esses resultados, comprovou-se que a cola apresenta eficácia significativa, demonstrando que sua utilização é 68,1 % mais efetiva que a drenagem de aspiração na prevenção de hematomas ou seromas em ritidoplastia. / This study aimed to compare the efficacy of fibrin glue and suction drainage in preventing postoperative complications such as hematoma and seroma following rhytidoplasties conducted by the staff of Clínica Rezende at Hospital Moinhos de Vento in Porto Alegre, Brazil. A prospective, controlled, randomized, double-blind trial was conducted. The 72 patients assessed in the study were divided into two groups of 36 each, one treated with suction drainage and other with fibrin glue. Forty-eight hours after the procedures, all patients underwent ultrasound evaluation of the volume of exudate under facial skin flaps. The average volume of exudate was 3.21 mL in the drainage group and 1.02 mL in the fibrin glue group, with a size effect of 68.1%, 95% confidence interval of 55.3 to 77.2, and p <0.001. The results of this investigation significant favor the use of fibrin glue, showing that was 68.1 % more effective than suction drainage in preventing hematoma or seroma following rhytidoplasty.

Este trabalho tem por objetivo comparar a eficácia da cola biológica de fibrina e da drenagem de aspiração pós-operatória na prevenção de complicações cirúrgicas como hematoma e seroma após a realização de ritidoplastia pela equipe da Clínica Rezende no Hospital Moinhos de Vento, na cidade de Porto Alegre/RS. Realizou-se estudo prospectivo, controlado, randomizado e duplo cego. Foram analisadas 72 pacientes, divididas em dois grupos de 36, sendo que no grupo dreno utilizou-se drenagem de aspiração e no grupo cola utilizou-se cola de fibrina. Quarenta e oito horas após a realização dos procedimentos, todas as pacientes foram submetidas a aferição ecográfica da lâmina de exsudato presente sob os retalhos cutâneos da face. O volume total médio foi de 3,21 mL no grupo dreno e 1,02 mL no grupo cola, com magnitude de efeito de 68,1% e intervalo de confiança de 55,3 a 77,2 e p <0,001. Com esses resultados, comprovou-se que a cola apresenta eficácia significativa, demonstrando que sua utilização é 68,1 % mais efetiva que a drenagem de aspiração na prevenção de hematomas ou seromas em ritidoplastia. / This study aimed to compare the efficacy of fibrin glue and suction drainage in preventing postoperative complications such as hematoma and seroma following rhytidoplasties conducted by the staff of Clínica Rezende at Hospital Moinhos de Vento in Porto Alegre, Brazil. A prospective, controlled, randomized, double-blind trial was conducted. The 72 patients assessed in the study were divided into two groups of 36 each, one treated with suction drainage and other with fibrin glue. Forty-eight hours after the procedures, all patients underwent ultrasound evaluation of the volume of exudate under facial skin flaps. The average volume of exudate was 3.21 mL in the drainage group and 1.02 mL in the fibrin glue group, with a size effect of 68.1%, 95% confidence interval of 55.3 to 77.2, and p <0.001. The results of this investigation significant favor the use of fibrin glue, showing that was 68.1 % more effective than suction drainage in preventing hematoma or seroma following rhytidoplasty.

Orientador : Antonio Guilherme Borges Neto / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T04:48:47Z (GMT). No. of bitstreams: 1 Fernandes_YvensBarbosa_D.pdf: 3014362 bytes, checksum: 3e19916b23a554cf98f832ccdd9d494f (MD5) Previous issue date: 2002 / Resumo: Tumores, aneurismas, hematomas e outras lesões situadas nas fossas cranianas anterior ou média ou mesmo convexidade são abordados, geralmente, através de craniotomia. Novas técnicas têm sido utilizadas para abordar a órbita, a fossa anterior e a base do crânio. Com o advento do neuroendoscópio, abordagens supra-orbitárias demonstraram uma boa visualização anatômica da chamada 'pirâmide virtual supra-selar¿. A combinação da neuroendoscopia com a microneurocirurgia permitiu a redução do tamanho da craniotomia requerida para uma boa visualização de tumores, aneurismas, hematomas e estruturas circunvizinhas. Neste trabalho foi reportada a nossa experiência no uso de abordagem minimamente invasiva de lesões da base do crânio e hematomas traumáticos, nos quais bons resultados foram obtidos / Abstract: Frequently tumors, aneurysms, hematomas, and other lesions situated in the anterior or middle cranial fossae or skull convexity are approached by craniotomy. Some other new techniques are also used to approach the orbit, anterior fossa and skull base. Recently several supraorbital endoscopic ¿keyhole¿ approaches have been developed and have demonstrated a good anatomic visualization of the so-called 'suprasellar virtual pyramid¿ with the aid of an endoscope. Combination of endoscopy and microneurosurgery permits the reduction of the size of the craniotomy required for good visualization of tumor, aneurysm, hematomas and surrounding structures if compared to traditional techniques. On this thesis we reported our experience with minimally invasive approach to skull base lesions and convexity traumatic hematomas, in which good results were obtained. / Doutorado / Neurologia / Doutor em Ciências Médicas

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Publicación a texto completo no autorizada por el autor / Identifica la morbimortalidad que causa el Hematoma Retroperitoneal Traumático en pacientes mayores de 15 años atendidos en el servicio de Cirugía en el Hospital Nacional Daniel Alcides Carrión, en el periodo de enero 2007 a diciembre del 2011. Se realizó un estudio descriptivo, transversal y retrospectivo, en el que se revisaron las historias clínicas y libro de reporte operatorio. Se obtuvo una muestra de 81 pacientes con los criterios de inclusión; 95 % fueron de sexo masculino. El rango de edad más frecuente fue de 15 a 34 años. La incidencia de trauma abierto fue de 77 %; y de trauma cerrado, de 23 %, siendo el principal mecanismo de lesión el producido por proyectil de arma de fuego (61.7%). El diagnóstico se realizó en el intraoperatorio en un 77 % y por tomografía en 15 %. Se realizó tratamiento quirúrgico en el 83%. El hematoma retroperitoneal se localizó con mayor frecuencia en la Zona II (70%), las estructuras lesionadas que predominaron fueron la vena cava en la Zona I (50%), los riñones en la Zona II (40%) y los vasos de mediano calibre en la Zona III (22%). La principal lesión asociada fue el trauma yeyunal. Se determinó una mortalidad de 3,7 %. El hematoma retroperitoneal traumático tiene su mayor incidencia en los pacientes adolescentes y adultos jóvenes de sexo masculino, con antecedentes de consumo de drogas. El diagnóstico fue principalmente por acto quirúrgico. El trauma abierto es el tipo de lesión más frecuente en el espacio retroperitoneal y la principal causa es por arma de fuego. La región anatómica donde se localizó con más frecuencia el hematoma retroperitoneal fue la Zona II, entre ellas el izquierdo, y el órgano más lesionado dependía de la zona retroperitoneal afectada. / Trabajo de investigación

Intracerebral hemorrhage defines a category of neurological disease that spans the full range of possible clinical outcomes. At one end of the spectrum is hemorrhagic stroke, an often debilitating neurologic condition with substantial morbidity and mortality while cerebral microhemorrhage at the other end of the spectrum can go completely unnoticed as they are often asymptomatic. Despite the distinct clinical outcomes both conditions share a common risk factor, uncontrolled hypertension. Here we set out to generate a novel mouse model of intracerebral hemorrhage with pressure as the mode of hemorrhage induction. To conduct our studies, we utilize high pressure focused ultrasound in combination with injected microbubbles to cause hemorrhage. We applied this technique at two different pressures resulting in striatal hemorrhage induction with distinct phenotypic outcomes. Following induction at the higher-pressure, mice show evidence of lateral motor deficit and other signs of impairment. Mice with hemorrhage induced at the lower pressure show no behavioral signs of neurological deficit. We employ immunofluorescence and western blotting to understand the cellular responses to intracerebral hemorrhage in these mice. We find evidence of inflammation and cell death following high-pressure induction of intracerebral hemorrhage. Lower pressure induction of intracerebral hemorrhage lacks signs of cell death but shows apparent inflammation. We have created a novel pressure-dependent mouse model of symptomatic and asymptomatic intracerebral hemorrhage by applying high intensity focused ultrasound in combination with circulating microbubbles.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18647号 / 医博第3946号 / 新制||医||1006(附属図書館) / 31561 / 京都大学大学院医学研究科医学専攻 / (主査)教授 福山 秀直, 教授 平岡 眞寛, 教授 宮本 享 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DGAM

Parenteral anticoagulants are vital in the prevention of thrombus formation and thus, are commonly used in a hospital setting. A thrombus can restrict blood flow where formed such is the case with deep vein thrombosis (DVT). They may also become dislodged forming an emboli, which may travel and become lodged in the lungs, causing a pulmonary emboli, or other vessels including those going to the brain, causing a stroke. While anticoagulants are many times necessary, when given subcutaneously, they have been associated with pain, purpura, melena, hematuria, osteoporosis, thrombocytopenia, and hematoma formation. While hematoma formation has not proven to be life threatening, it does lead to increased patient discomfort, distorted body image, and may lead to surgery. Different methods of preventing hematoma formation have been studied with regards to anticoagulant injection technique though no method has been consistently substantiated by the research or adopted by nursing texts.

INTRODUÇÃO: A formação do hematoma intraneural com comprometimento dos nervos periféricos pode ocorrer após traumas ou em associação com distúrbios de coagulação. A opção por conduta conservadora (expectante) ou descompressão cirúrgica ainda é controversa. Essas duas condutas foram analisadas comparativamente por meio de modelo experimental em ratos submetidos a hematoma intraneural associado à compressão extrínseca. MATERIAL E MÉTODOS: Cinqüenta ratos Wistar foram divididos em 5 grupos. Em 4 grupos (A, B, C e D) o nervo ciático direito foi envolvido por tubo de silicone de diâmetro interno maior que o do nervo, simulando o trajeto do nervo periférico através de regiões inextensíveis (exemplo: túnel do carpo). No grupo B, foi realizada injeção intraneural no segmento envolvido pelo tubo de 0,2 ml de sangue autógeno. No grupo C, após produção do hematoma, foi feita a imediata remoção do tubo de silicone simulando-se a descompressão túnel do carpo, e epineurotomia longitudinal complementar. No grupo D, após produção do hematoma, foi realizada apenas a remoção do tubo de silicone. No grupo E (CONTROLE) o nervo foi apenas exposto sem a presença de hematoma ou compressão extrínseca. A avaliação funcional foi feita periodicamente durante 61 dias através do Índice de Função Ciática (IFC) de Bain-Mackinnon-Hunter, e a análise histomorfométrica realizada ao término deste período. RESULTADOS: O grupo A (compressão extrínseca) apresentou IFC inicial de -26,29±2,89 com retorno aos valores pré-operatórios no 5º dia de pós-operatório. O grupo B (hematoma e compressão extrínseca) foi aquele com pior função ciática inicial (IFC -85,23±3,51) com recuperação da função no 23º dia. O grupo C apresentou IFC inicial de -32,78±7,45 com normalização no 5º dia. O grupo D apresentou IFC inicial de -45,13±6,84 com normalização da função ciática no 5º pós-operatório. A análise estatística do IFC identificou diferença significativa (p<0,0001) entre a conduta expectante (grupo B) e o tratamento cirúrgico descompressivo (grupos C e D) até o 19° dia. O número e a densidade de fibras mielínicas em degeneração foi significativamente maior no grupo B quando comparado aos outros grupos. CONCLUSÃO: Neste estudo experimental, descompressão cirúrgica e epineurotomia reduziram a perda de fibras mielínicas e determinaram recuperação funcional mais rápida. / INTRODUCTION: Intraneural hematoma can result in the median nerve in the carpal tunnel after trauma or coagulation disorders. The decision for expectant management or descompressive surgical techniques is still controversial. MATERIAL AND METHODS: Fifty male Wistar rats were divided into 5 groups. The sciatic nerve was wrapped around with a silastic device in 4 groups. Group A the sciatic nerve was just wrapped by the silastic tube. In group B an intraneural injection of autologous blood was added. In group C, after the hematoma creation the silastic device was removed and a longitudinal epineurotomy was performed. In group D, we removed the silastic device after the hematoma but the nerve was not opened. In the group E (sham-operated) sciatic nerve was exposed without hematoma or compression. Nerve function recovery was assessed periodically over 61 days using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI). RESULTS: Group A (extrinsic compression) presented initial SFI of -26.29±2.89, with return to baseline values on the 5th postoperative day. Group B (hematoma and extrinsic compression) exhibited the poorest function (SFI - 85.23±3,51) after surgery and recovery in 23 days. Group C (liberation of silastic and hematoma drainage through epineurotomy) and Group D (only removal of the silastic tube) presented similar initial SFI values of - 32.78±7.45 and - 45.13±6.84, respectively. In both groups SFI values returned to baseline level on 5th postoperative day. The statistical analysis of SFI identified a significant difference (p<0.0001) between the expectant management (group B) and the descompressive surgery approach (groups C & D) by 1st to 19th postoperative day. The number of degenerative fibers and density of degenerative fibers were statistically significant bigger in the group B when compared to the other groups. There was no statistical difference between the other groups when these parameters were analysed. CONCLUSION: Thus, immediate descompressive procedures of the intraneural hematoma provide a faster functional recovery and reduce the damage to the axon fibers.

We propose a new approach for defining mechanical properties of the brain tissue in-vivo by taking MRI or CT images of a brain response to ventriculostomy operation, i.e., the relief of the elevated pressure in the ventricular cavities. Then, based on 3-D image analysis, the displacement fields are recovered from these images. Constitutive parameters of the brain tissue are determined using inverse analysis and a numerical method allowing for computations of large strain deformations. We tested this approach in controlled laboratory experiments with silicone brain models mimicking brain geometry, mechanical properties, and boundary conditions. The ventriculostomy was simulated by inflating and deflating internal cavities that model cerebral ventricles. Subsequently, the silicone brain model was described by a hyperelastic (neo-Hookean) material. The obtained mechanical properties have been verified with direct laboratory tests. Properties of real brain tissue are more complicated, but the proposed approach requires only conventional medical images collected before and after ventriculostomy. Breast cancer is the second most prevalent cancer in women, and an operative mastectomy is frequently a part of the treatment. Women often choose to follow a mastectomy with a reconstruction surgery using a breast implant. Furthermore, there is a growing demand for breast augmentation for the sake of aesthetic improvement. In this dissertation, we also developed a quantitative large-strain 3-D mechanical model of female breast deformation. The results show that the stiffness of skin and the constitutive parameters of the breast tissue are important factors affecting breast shape. Our results also suggest that the published Mooney-Rivlin parameters of breast tissue are underestimated by at least one or two orders of magnitude. Scale analysis, representing female breast as a cantilever beam, confirms these conclusions. Subdural hematoma (tearing and bleeding between scull and brain) is one of the major complications of the ventriculostomy operations. Understanding the mechanism of subdural hematoma is critically important for development of more effective medical treatments. In this work, we developed a simple, spherically-symmetrical poroelastic model of the ventriculostomy operation and studied brain response to the pressure change in the ventricles. The observed effect of the material properties on the occurrence of subdural hematoma may be useful for making clinical decisions.