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Santo André, Brazil

Pompeu J.E.,University of Sao Paulo | Romano R.S.L.,Hospital das Clinicas | Pompeu S.M.A.A.,University of Sao Paulo | Lima S.M.A.L.,ABC Medical School
Revista Brasileira de Reumatologia

To analyze the musculoskeletal changes of individuals with ankylosing spondylitis (AS) and their repercussions on postural control, a literature review was carried out in the BIREME and EBSCO HOTS databases and Pubmed site with the following keywords: "ankylosing spondylitis", "postural balance", and "posture". Articles involving human beings, assessing the postural control and balance of individuals with AS, written in English or Portuguese and published between 1999 and 2010, were selected. Of the total number of articles found, only four met the requirements. Of those, three compared the outcomes of patients with AS with data obtained from healthy individuals, and one article assessed individuals with AS. No article used the same method of postural analysis. To assess balance, Berg Balance Scale, Force Plate, and Magno metry were used. The major postural deviations found were increased thoracic kyphosis and hip flexion, which lead to a forward displacement of the body's center of gravity, with knee flexion and ankle plantar flexion as compensation to control balance. Only one author reported worsening of functional balance in subjects with AS. All assessment methods used were considered capable of measuring balance, and no specific scale for patients with AS exists. © 2012 Elsevier Editora Ltda. All rights reserved. Source

Da Cunha M.G.,University of Sao Paulo | Fonseca F.L.A.,University of Sao Paulo | Fonseca F.L.A.,Federal University of Sao Paulo | MacHado C.D.A.S.,ABC Medical School

Acne in adult women is a hard-to-manage frequent disease with many relapse cases. It mostly interferes with quality of life and causes major social and metabolic losses for patients. This is a transversal retrospective study and the aim was to standardize the research on circulating androgenic hormone levels and to detect hyperandrogenic states early, showing the frequency and the pattern of the altered hormones, useful resources to correctly evaluate each patient. In this study 835 women above 15 years of age, with acne or aggravation cases, were analyzed. The aim was to verify the percentage of androgen examinations with levels above normal. The levels of the hormones dehydroepiandrosterone sulfate, dehydroepiandrosterone (DHEA), dehydrotestosterone, androstenedione and total testosterone were measured in all patients. The evaluation of the hormone profile showed that 54.56% of the patients had hyperandrogenism, and the levels of DHEA were most frequently elevated. Therefore, in the face of the importance of hyperandrogenism in the pathogenesis of acne, standardizing the research of the hormone profile is paramount for the treatment and control of relapses in case of a surge of acne breakouts during a woman's adult life. © 2013 S. Karger AG, Basel. Source

Tobias-Machado M.,ABC Medical School
International braz j urol : official journal of the Brazilian Society of Urology

Pelvic organ prolapse is an ordinary disease with around 200.000 surgeries performed annually in the US to treat this condition. The surgical treatment for complete vaginal vault prolapse after hysterectomy involves abdominal or vaginal sacrocolpopexy. The purpose of this video is to demonstrate the steps of a laparoendoscopic single-site surgery (LESS) sacrocolpopexy performed by a simplified knotless technique. A 52 year-old female submitted a total hysterectomy five years ago due to miomatosis who developed vault prolapse and urinary incontinence after surgery. She was treated by transumbilical LESS cutaneous retractor and a surgical glove attached to three trocars through a 3.5 cm umbilical incision. Patient was positioned in lithotomy, the Y-shape polypropylene mesh was passed through the trocar. Only conventional laparoscopic instruments were used for intrabdominal dissection of vagina and peritoneum. The mesh was fixed to the vaginal fornix using 3 continuous sutures held in extremities by polymeric clips. The last helical suture was fixed by polymeric clips to the sacral periosteum from the promontory to achieve good vaginal positioning without tension. The posterior peritoneum was closed over the mesh. The operative time was 150 minutes, blood loss of approximately 100 mL and the patient was discharged after 18 hours with no immediate complications and a 3 months follow-up free of vault prolapse and urinary incontinence until now. LESS sacrocolpopexy performed with conventional instruments is feasible and a safe procedure reproducing surgical steps of conventional laparoscopic or robotic surgery. Source

Tobias-Machado M.,ABC Medical School
International braz j urol : official journal of the Brazilian Society of Urology

The indication for surgery in locally advanced prostate cancer is growing considering and long-term follow-up shows that 60-80% of patients can be free of clinical recurrence. The aim of this video is demonstrate the modifications in traditional laparoscopic surgery that permit to observe the oncological principles reproducing open surgery. A 55 years-old male presented with an initial PSA = 25ng/dL, the digital rectal examination found a prostate with hardened nodules bilaterally (clinical stage T2c). Prostate biopsy showed an adenocarcinoma Gleason 7, the patient's disease was classified as a localized high-risk prostate cancer. Surgery was offered as initial therapeutic option and the critical technical points were: transperitoneal approach to evaluate if separation of rectum from prostate and seminal vesicles was possible, extended pelvic lymphadenectomy, opening of endopelvic fascia lateral to the prostate, bladder neck section without preservation, pedicle control without neurovascular bundle preservation, meticulous dissection of apical region, reconstruction of posterior bladder neck before the anastomosis. The operative time was 240 minutes without conversion to open surgery and an estimated blood loss around 520 mL. Neither intraoperative nor postoperative complications occurred and the hospital stay was about 36 hours. Pathological report confirmed a prostate adenocarcinoma Gleason 4+4, negative margins and stage pT3a pN0 pMx. Laparoscopic surgery adopting oncological principles can be utilized with efficacy to selected patients with high risk localized and locally advanced prostate cancer maintaining the advantages of minimally invasive surgical approach. Source

Neto A.S.,ABC Medical School | Cardoso S.O.,ABC Medical School | Manetta J.A.,ABC Medical School | Pereira V.G.M.,ABC Medical School | And 4 more authors.
JAMA - Journal of the American Medical Association

Context: Lung-protective mechanical ventilation with the use of lower tidal volumes has been found to improve outcomes of patients with acute respiratory distress syndrome (ARDS). It has been suggested that use of lower tidal volumes also benefits patients who do not have ARDS. Objective: To determine whether use of lower tidal volumes is associated with improved outcomes of patients receiving ventilation who do not have ARDS. Data Sources: MEDLINE, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials up to August 2012. Study Selection: Eligible studies evaluated use of lower vs higher tidal volumes in patients without ARDS at onset of mechanical ventilation and reported lung injury development, overall mortality, pulmonary infection, atelectasis, and biochemical alterations. Data Extraction: Three reviewers extracted data on study characteristics, methods, and outcomes. Disagreement was resolved by consensus. Data Synthesis: Twenty articles (2822 participants) were included. Meta-analysis using a fixed-effects model showed a decrease in lung injury development (risk ratio [RR], 0.33; 95% CI, 0.23 to 0.47; I2, 0%; number needed to treat [NNT], 11), and mortality (RR, 0.64; 95% CI, 0.46 to 0.89; I2, 0%; NNT, 23) in patients receiving ventilation with lower tidal volumes. The results of lung injury development were similar when stratified by the type of study (randomized vs nonrandomized) and were significant only in randomized trials for pulmonary infection and only in nonrandomized trials for mortality. Metaanalysis using a random-effects model showed, in protective ventilation groups, a lower incidence of pulmonary infection (RR, 0.45; 95% CI, 0.22 to 0.92; I 2, 32%; NNT, 26), lower mean (SD) hospital length of stay (6.91 [2.36] vs 8.87 [2.93] days, respectively; standardized mean difference [SMD], 0.51; 95% CI, 0.20 to 0.82; I2, 75%), higher mean (SD) PaCO 2 levels (41.05 [3.79] vs 37.90 [4.19]mm Hg, respectively; SMD, -0.51; 95% CI, -0.70 to -0.32; I 2, 54%), and lower mean (SD) pH values (7.37 [0.03] vs 7.40 [0.04], respectively; SMD, 1.16; 95% CI, 0.31 to 2.02; I 2, 96%) but similar mean (SD) ratios of PaO 2 to fraction of inspired oxygen (304.40 [65.7] vs 312.97 [68.13], respectively; SMD, 0.11; 95% CI, -0.06 to 0.27; I 2, 60%). Tidal volume gradients between the 2 groups did not influence significantly the final results. Conclusions: Among patients without ARDS, protective ventilation with lower tidal volumes was associated with better clinical outcomes. Some of the limitations of the meta-analysis were the mixed setting of mechanical ventilation (intensive care unit or operating room) and the duration of mechanical ventilation. ©2012 American Medical Association. All rights reserved. Source

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