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Porto Alegre, Brazil

Martha V.F.,Pontifical Catholic University of Rio Grande do Sul | da Silva Moreira J.,Federal University of Rio Grande do Sul | Martha A.S.,Pontifical Catholic University of Rio Grande do Sul | Velho F.J.,Pontifical Catholic University of Rio Grande do Sul | And 2 more authors.
International Journal of Pediatric Otorhinolaryngology | Year: 2013

Introduction: Adenotonsillar hypertrophy is a common condition in pediatric patients with upper respiratory airways complaints, and pulmonary arterial hypertension (PAH) may be one complication of that condition. Objectives: To study the occurrence of PAH (mean pulmonary artery pressure higher than or equal to 25. mmHg) in a group of children with adenotonsillar hypertrophy and upper respiratory complaints (snoring or oral breathing), and to verify the pulmonary arterial pressure (PAP) changes after adenotonsillectomy. Study design: Case-control prospective study. Settings: Study conducted at São Lucas Hospital, approaching both public and private sector. Subject and methods: Thirty-three pediatric patients with adenotonsillar hypertrophy and evidence of obstructive upper airways complaints were treated with adenotonsillectomy. All 33 patients underwent echocardiogram before and after the surgery with determination of the pulmonary arterial pressure (PAP), through either the tricuspid regurgitation or artery linear flow acceleration time estimation. Similar determinations were performed in 10 normal non operated controls. Results: Pulmonary hypertension was verified 12 (36%) of the 33 patients with adenotonsillar hypertrophy. Adenoidectomy or adenotonsillectomy was associated to a significant 27% decrease in mean PAP (27±2.8 to 20±5.1 mmHg, p<0.001) and to a non significant 26% decrease in systolic PAP (35±6.2mmHg to 25±0.5mmHg, p=0.243). The PAP values in children with no pulmonary hypertension were not changed after the surgery. Conclusions: In children with pulmonary hypertension associated to adenotonsillar hypertrophy, the adenotonsillectomy decreased PAP to normal values in all patients. © 2012 Elsevier Ireland Ltd.

Luca F.,Italian National Cancer Institute | Valvo M.,Italian National Cancer Institute | Ghezzi T.L.,Moinhos de Vento Hospital | Zuccaro M.,Italian National Cancer Institute | And 4 more authors.
Annals of Surgery | Year: 2013

BACKGROUND: Urinary and sexual dysfunctions are recognized complications of rectal cancer surgery. Their incidence after robotic surgery is as yet unknown. The aim of this study was to prospectively evaluate the impact of robotic surgery for rectal cancer on sexual and urinary functions in male and female patients. METHODS AND PROCEDURES: From April 2008 to December 2010, 74 patients undergoing fully robotic resection for rectal cancer were prospectively included in the study. Urinary and sexual dysfunctions affecting quality of life were assessed with specific self-administered questionnaires in all patients undergoing robotic total mesorectal excision (RTME). Results were calculated with validated scoring systems and statistically analyzed. RESULTS: The analyses of the questionnaires completed by the 74 patients who underwent RTME showed that sexual function and general sexual satisfaction decreased significantly 1 month after intervention: 19.1 ± 8.7 versus 11.9 ± 10.2 (P < 0.05) for erectile function and 6.9 ± 2.4 versus 5.3 ± 2.5 (P < 0.05) for general satisfaction in men; 2.6 ± 3.3 versus 0.8 ± 1.4 (P < 0.05) and 2.4 ± 2.5 versus 0.7 ± 1.6 (P < 0.05) for arousal and general satisfaction, respectively, in women. Subsequently, both parameters increased progressively, and 1 year after surgery, the values were comparable to those measured before surgery. Concerning urinary function, the grade of incontinence measured 1 year after the intervention was unchanged for both sexes. CONCLUSIONS: RTME allows for preservation of urinary and sexual functions. This is probably due to the superior movements of the wristed instruments that facilitate fine dissection, coupled with a stable and magnified view that helps in recognizing the inferior hypogastric plexus. Copyright © 2013 by Lippincott Williams & Wilkins.

Hochhegger B.,Federal University of Health Sciences, Porto Alegre | Marchiori E.,Federal University of Rio de Janeiro | Irion K.,Liverpool Heart and Chest Hospital | Volkart J.,Moinhos de Vento Hospital | Rubin A.S.,Santa Casa Sisters of Mercy Hospital Complex
Jornal Brasileiro de Pneumologia | Year: 2012

Magnetic resonance imaging (MRI) of the lung has progressed tremendously in recent years. Because of improvements in speed and image quality, MRI is now ready for routine clinical use. The main advantage of MRI of the lung is its unique combination of structural and functional assessment in a single imaging session. We review the three major clinical indications for MRI of the lung: staging of lung tumors; evaluation of pulmonary vascular disease; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

Hochhegger B.,Moinhos de Vento Hospital | Alves G.R.T.,Federal University of Santa Maria | Irion K.L.,Liverpool Heart and Chest Hospital NHS Foundation Trust | Moreira J.S.,Santa Casa Sisters of Mercy Hospital Complex in Porto Alegre | Marchiori E.S.,Federal University of Rio de Janeiro
Jornal Brasileiro de Pneumologia | Year: 2012

Objective: To investigate the effects of age on pulmonary emphysema, based on the values of the emphysema index (EI) in a cohort of patients who had never smoked and who had no recognizable lung disease. Methods: We reviewed the CT scans, reported as normal, of 315 patients. Exclusion criteria were a history of smoking, cardiorespiratory disease, and exposure to drugs that could cause lung disease. From this cohort, we selected 32 patients (16 men and 16 women), matched for gender and body mass index, who were divided equally into two groups by age (< 50 years and ≥ 50 years). We quantified emphysema using a computer program specific to that task. The EI was calculated with a threshold of -950 HU. We also evaluated total lung volume (TLV) and mean lung density (MLD). Results: The overall means for TLV, MLD, and EI were 5,027 mL, -827 HU, and 2.54%, respectively. Mean values in the older and younger groups, respectively, were as follows: for TLV, 5,229 mL vs. 4,824 mL (p > 0.05); for MLD, -846 HU vs. -813 HU (p < 0.04); and for EI, 3.30% vs. 1.28% (p < 0.001). Significant correlations were found between EI and age (r = 0.66; p = 0.001), EI and TLV (r = 0.58; p = 0.001), and EI and MLD (r = -0.67; p < 0.001). The predicted EI per age was defined by the regression equation (r2 = 0.43): p50(EI) = 0.049 × age - 0.5353. Conclusions: It is important to consider the influence of age when quantifying emphysema in patients over 50 years of age. Based on the regression analysis, EI values of 2.6%, 3.5%, and 4.5% can be con sidered normal for patients 30, 50, and 70 y ears of age, respectively.

Averbeck M.A.,Moinhos de Vento Hospital | Altaweel W.,King Faisal Specialist Hospital And Research Center | Manu-Marin A.,Spitalul Prof D GerotaBucharestRomania | Madersbacher H.,Innsbruck Medical University
Neurourology and Urodynamics | Year: 2015

Aims: To systematically review the management of lower urinary tract symptoms (LUTS) in patients with dementia and associated disorders. Methods: This systematic review was performed according to the PRISMA statement. Studies were identified by electronic search of Embase and Medline databases (last search August 2015) and by screening of reference lists and reviews. Results: Of 1,426 abstracts that were screened, 102 full-text articles were identified and assessed for eligibility. Seventy-six articles were then included in the quantitative synthesis. Urinary incontinence (UI) prevalence rates in dementia patients have varied considerably, ranging from 11 to 93%. In Alzheimer's disease patients, UI usually correlates with disease progression (late-stage dementia). In contrast, LUTS usually precede severe mental failure in Lewy body disease and in vascular dementia. Behavioral therapy, including toilet training and prompted voiding, may be especially useful in patients with unawareness UI. High-quality data to guide the choice of treatment strategies in this population are lacking. Current evidence suggests that antimuscarinics, especially oxybutynin, can be associated with cognitive worsening, due to the blockade of M1 receptors. Thus, the use of antimuscarinics that do not easily cross the blood-brain barrier or are more M2/M3 selective should be considered. No data are available for beta-3 agonists so far. Conclusion: Different types of dementia cause different LUTS at varying time points during the disease process and need singular therapeutic approaches. Treatment of LUTS should be tailored to individual patient needs and disease status, considering factors like mobility, cognitive function, and general medical condition. © 2015 Wiley Periodicals, Inc.

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