International Journal of Abdominal Wall and Hernia Surgery, 2020
PURPOSE: The aim of this study was to compare the effects of self-gripping mesh and prolene mesh ... more PURPOSE: The aim of this study was to compare the effects of self-gripping mesh and prolene mesh fixed with staples on postoperative pain in patients undergoing videolaparoscopic inguinal herniorrhaphy by the transabdominal preperitoneal (TAPP) technique. MATERIALS AND METHODS: The study analyzed data from 52 patients (46 males, mean age 54.9 years, 51.9% right-sided hernias) who underwent TAPP. They were operated on consecutively and randomly in two groups of 26 patients each: Group 1 with self-gripping mesh and Group 2 with endoscopic tacker-fixed prolene mesh. Each patient's postoperative pain was recorded twice using a visual analog scale (VAS) at 6 and 24 h after the surgery. Patients were followed up to 10 months after the surgery. RESULTS: The median VAS score at 6 h for all patients was 3. The median score at 24 h was 1. The median VAS scores of the two groups were different at 6 h: In Group 1, the median score was 2, whereas in Group 2, it was 3 (P = 0.053). At 24 h, there was no difference between the groups, with a median score of 1 in both (P = 0.277). CONCLUSION: There was no statistically significant difference between groups according to postoperative pain (after 6 h and after 24 h). Studies with larger samples are needed to compare self-gripping mesh with tacker fixation in laparoscopic inguinal hernia repairs. The technique performed was safe and reproducible, with a low complication rate, early patient discharge, and good postoperative recovery.
Revista do Colegio Brasileiro de Cirurgioes, Jan 26, 2018
to evaluate and compare the early postoperative period systemic inflammatory response between eld... more to evaluate and compare the early postoperative period systemic inflammatory response between elderly and non-elderly patients submitted to laparoscopic cholecystectomy, mainly performing a quantitative analysis of interleukin-6 (IL-6), a marker of inflammatory activity systemic. we compared a series of cases over a period of six months at the Gaffrée and Guinle University Hospital of the Federal University of the State of Rio de Janeiro, involving 60 patients submitted to elective laparoscopic cholecystectomy. We used non-probabilistic sampling for convenience, selecting, from the inclusion criteria, the first 30 patients aged 18-60 years, who comprised group I, and 30 patients with age equal to or greater than 60 years, who formed group II. the 60 patients involved were followed for at least 30 days after surgery and there were no complications. There was no conversion to open surgery. The values of the medians found in the IL-6 dosages for the preoperative period, three hours a...
to describe the implementation of a training program in robotic surgery and to point the General ... more to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major co...
OBJETIVO: Determinar a prevalência da síndrome de dumping em uma série de casos submetidos ao byp... more OBJETIVO: Determinar a prevalência da síndrome de dumping em uma série de casos submetidos ao bypass gástrico, baseado em critérios clínicos, e caracterizar seus principais aspectos. MÉTODOS: Foi realizada uma análise dos sintomas descritos como dumping em 34 pacientes obesos mórbidos submetidos ao bypass gástrico com reconstrução em Y de Roux, por meio do preenchimento de um questionário que incluiu um sistema de escore para o diagnóstico clínico da síndrome de dumping, descrito por Sigstad. RESULTADOS: A ocorrência de dumping com base em critérios subjetivos foi de 44%. Aplicando o escore para diagnóstico clínico, a ocorrência foi de 76%. Os sintomas mais freqüentes foram "vontade de deitar" (88%), cansaço (69%) e sono (69%). Apenas 28% dos pacientes com dumping se sentiram incapacitados para a realização das atividades cotidianas. Não foi observada diferença entre o percentual de perda de peso dos pacientes dumpers e não-dumpers. CONCLUSÃO: O escore de Sigstad se mostro...
OBJETIVO: A gastrostomia, realizada para possibilitar acesso nutricional ou descompressão, é comu... more OBJETIVO: A gastrostomia, realizada para possibilitar acesso nutricional ou descompressão, é comumente realizada por via endoscópica, por radiologia intervencionista, e, mais raramente, por via cirúrgica através de videolaparoscopia ou incisão mediana supra-umbilical. Os métodos endoscópico e radiológico, apesar de estabelecidos em muitos centros, não constituem rotina em hospitais comunitários pela necessidade de pessoal qualificado e material descartável, sendo usualmente realizada a gastrostomia cirúrgica com incisão mediana e anestesia geral. A Gastrostomia de Incisão Única descrita neste trabalho é um novo método cirúrgico menos invasivo, que foi desenvolvido para ser realizado sob anestesia local, com uma única incisão e sem necessidade de equipamento especial. MÉTODO: Quinze pacientes elegíveis para gastrostomia por diferentes indicações foram operados sob anestesia local. Após incisão subcostal de 1cm sobre o músculo reto abdominal esquerdo, uma área de parede gástrica era l...
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, Jan 21, 2018
Surgeries with single port access have been gaining ground among surgeons who seek minimally inva... more Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias. To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port. A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias. Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique. There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
All available treatments for achalasia are palliative and aimed to eliminate the flow resistance ... more All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied. The evaluation protocol with dysphagia scores compared preoperative, immediate (up to three months) postoperative and late (over one year) postoperative scores to estimate quality of life. The surgical procedure was Heller-Dor in 100% of cases, with 84 cases performed laparoscopically. The percent reduction in pre- and immediate postoperative lower esophageal sphincter pressurewas 60.35% in the success group and 32.49% in the failure group. Regarding the late postoperative perio...
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2015
In the surgical treatment of colorectal cancer, a lymphadenectomy is considered adequate when at ... more In the surgical treatment of colorectal cancer, a lymphadenectomy is considered adequate when at least 12 lymph nodes are removed. To evaluate whether videolaparoscopic surgery positively affects the rates of adequate lymphadenectomy. An observational study was conducted with patients undergoing either open or videolaparoscopic surgery for colorectal cancer between 2008 and 2013. The following variables were collected: gender, age, tumor site, histology, degree of differentiation, tumor stage, number of lymph nodes removed, and number of lymph nodes affected by the disease. A total of 62 patients with colorectal cancer were included; 42 (67.7%) received open surgery, and 20 (32.3%) laparoscopic surgery. Regarding lymphadenectomy, a mean of 13 lymph nodes (95% CI: 10-16) were removed in the group that received open surgery, while 19 lymph nodes were removed (95% CI: 14-24) in the laparoscopic surgery group (p=0.021). Adequate lymphadenectomy (removal of at least 12 lymph nodes) was achieved in 58.1% of the total cases, in 50.0% of the patients who received open surgery, and in 75% of those who received laparoscopic surgery. Non-elderly patients and those with an advanced disease stage were more likely to receive an adequate lymphadenectomy (p=0.004 and p=0.035, respectively). Disease stage and patient age were the factors that had the greatest influence on achieving an adequate lymphadenectomy. The type of surgery did not affect the number of lymph nodes removed.
ABSTRACT A multiclass method has been optimized and validated for the simultaneous determination ... more ABSTRACT A multiclass method has been optimized and validated for the simultaneous determination of 113 pesticides residues belonging to several classes in peanuts. It has been based on QuEChERS methodology (quick, easy, cheap, effective, rugged and safe) and ultra high performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry (UHPLC–MS/MS). Several extraction solutions were tested and the composition that showed the best results consisted of a mixture of ethyl acetate and acetonitrile. A cleanup step using dispersed phase C18 (octadecyl) and PSA (Primary and Secondary Amine) was necessary due to the high amount of oil present in the matrix. The method was validated and the parameters of validation were satisfactory. The accuracy was assessed by calculating the recovery of spiked blank samples in four concentration levels (0.010; 0.025; 0.050 and 0.100 mg/kg). The results showed satisfactory recoveries (between 70 - 120 %), except for oxamyl and tricyclazol at 0.010 mg/kg level that did not show acceptable parameters for the recovery assays. Repeatability and intermediate precision aggraded showed coefficients of variation < 20%, except for buprofenzin, etione and picolinafem at 0.100 mg/kg level. Limits of detection and quantification of the method were 0.005 and 0.010 mg/kg, respectively, except for oxamyl and tricyclazol.
To evaluate the surgical outcomes of Heller's Cardiomyotomy with Dor fundoplication by laparo... more To evaluate the surgical outcomes of Heller's Cardiomyotomy with Dor fundoplication by laparoscopy (HDL) and to assess its impact on patients' quality of life and on esophageal manometry data. 60 patients with esophageal achalasia, operated on between 2001 and 2007, were studied retrospectively. Before surgery, the demographics and the diagnostic test results were recorded. The patients submitted a dysphagia score for quality of life before and after surgery, and lower esophageal sphincter pressure (PLES) was measured. We also studied the difference produced in quality of life 37 women and 23 men were followed. Mean age was 41.08 (12-87). There was no mortality and no conversions. The mean time of diet resumption was 1.6 day. The outcome was considered excellent in 80% of the series and intermediate in 20% of the series. The mean dysphagia score before surgery was 9.03 points, and after surgery, 1.7 point (maximum of 10 points), p=0.0001. The mean score decrease between pre-...
Introduction. Laparoendoscopic single-site surgery (LESS) uses a multiple-entry portal in a singl... more Introduction. Laparoendoscopic single-site surgery (LESS) uses a multiple-entry portal in a single 3.0- to 4.0-cm incision in a natural scar, the umbilicus. The present study aimed to compare the inflammatory impact of classic video laparoscopic cholecystectomy (LC) versus LESS cholecystectomy. Methods. A prospective randomized controlled study was conducted from January to June 2011 at 2 university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients (53 women, 4 men; mean age = 48.7 years) were randomly assigned to receive LC (n = 29) or LESS (n = 28) cholecystectomy. C-reactive protein (CRP) and interleukin 6 (IL-6) were measured from blood samples collected during induction of anesthesia and at 3 and 24 hours postoperatively. Results. Median IL-6 levels in the LESS and LC groups, respectively, were 2.96 and 4.5 pg/mL preoperatively, 11.6 and 28.05 pg/mL at 3 hours postoperatively (P = .029), and 13.18 and 15.1 pg/mL at 24 hours postoperatively (P = .52). Median CRP levels in the LESS and LC groups, respectively, were 0.33 and 0.44 mg/mL preoperatively, 0.40 and 0.45 mg/mL (P = .73) at 3 hours postoperatively, and 1.7 and 1.82 mg/mL (P = .84) at 24 hours postoperatively. We did not find a significant association between IL-6 (and CRP) and body mass index in the LESS group. Conclusions. LESS cholecystectomy requires a larger size incision than LC. We found a tendency of less postoperative pain following LESS cholecystectomy than LC. There was also a tendency toward lower early inflammatory impact following LESS cholecystectomy versus LC.
Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, ... more Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0-4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complications, and postoperative pain of LESS compared with those of laparoscopic cholecystectomy (LC). A prospective randomized controlled study was conducted between January and June 2011 at two university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients were randomly assigned to undergo laparoscopic or LESS cholecystectomy. Skin and aponeurosis wound sizes were recorded. A 10-point visual analog scale (VAS) was used to assess pain at postoperative hours 3 and 24. Healing and wound complications were assessed at follow-up. A total of 57 patients, 53 women and 4 men with a mean age of 48.7 years, were randomly assigned to undergo LESS (n = 28) or LC (n = 29). The mean length of the umbilical skin incision was 4.0 cm (range = 2.1-5.8) in LESS and 2.7 cm (1.5-5.1) in LC (p < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0-5.5) in LESS and 2.3 cm (1.2-3.5) in LC (p < .0001). The mean operative time was 60.3 min (32-128) for LESS and 51.3 min (25-120) for LC (p = 0.11). Gallbladder perforation at detachment occurred in 15.69 % of the LESS cases and in 5.88 % of the LC cases (p = 0.028). The mean VAS score for pain at hour 3 was 2.0 points (0-7) for the LESS group and 4.0 (0-10) for the LC group (p = 0.07), and at postoperative hour 24 it was 0.3 points (0-6) for LESS and 2.3 (0-10) for LC (p = 0.03). There were no significant differences in wound complications. Incisional hernias were not found in either group. The LESS single-port (SP) operations demand a bigger incision than LC surgery. However, there were no differences in healing, wound infections, and hernia development. We found a tendency of less postoperative pain associated with LESS/SP than with LC.
ABSTRACT A multiresidue method for the quantification of 128 pesticides in banana is described. I... more ABSTRACT A multiresidue method for the quantification of 128 pesticides in banana is described. It involves the application of a modified QuEChERS procedure followed by UHPLC–MS/MS (Ultra High Performance Liquid Chromatography coupled to Tandem Mass Spectrometry) analysis. The method was validated according to the European Union SANCO/12495/2011 guidelines and Brazilian Manual of Analytical Quality Assurance. The validation levels were 10.0; 25.0; 50.0 and 100 μg kg−1. Acceptable values were obtained for the following parameters: linearity, limit of detection – LOD (5.00 μg kg−1) and limit of quantification – LOQ (10.0 μg kg−1), except for fenamiphos and mevinphos (LOD = 7.5 μg kg−1 and LOQ = 25 μg kg−1), trueness (for the levels: 10.0, 25.0, 50.0 and 100 μg kg−1 the recovery assays values were between 70 and 120%) except for methamidophos at 10 μg kg−1 level (67.5%), intermediate precision (<20.0%) and measurement uncertainty tests (<50.0%). These results demonstrate the applicability of this method in the routine practice by the laboratories of Ministry of Agriculture, Livestock and Food Supply of Brazil that attend the National Control Plan for Residues and Contaminants (PNCRC).
A method using QuEChERS extraction and LC-MS/MS in electrospray positive ionisation mode was deve... more A method using QuEChERS extraction and LC-MS/MS in electrospray positive ionisation mode was developed and validated for the analysis of 90 pesticides in a high water content matrix (tomato) in a single chromatographic run. To assess the intra-laboratory reproducibility of the method, validation was conducted on four different days by two different analysts. The validation data was treated using a spreadsheet developed in-house, which sets the most appropriate model for linear fit by determining whether the residuals of the calibration curves are homocedastic or heterocedastic. A statistical test for the significance of regression was also carried out. Calibration was always matrix-matched and the curves were obtained over the range 0.0075-0.10 or 0.020-0.125 mg kg(-1). Identification of analytes was based on retention times and MRM ratios. Recoveries were assessed at four different levels for each analyte and were between 73 and 106%, with relative standard deviations under reproducibility conditions of <20%. The measurement uncertainties of the method for each pesticide analysed were below 50%. Previous validation of the same method, applied to papaya samples and satisfactory results obtained in various proficiency tests with different high water content matrices, demonstrated the applicability of the method to these classes of commodities, without clean-up. The validated method will be applied routinely in the pesticide residues monitoring programme that constitutes the National Residue and Contaminant Control Plan of Brazil.
International Journal of Abdominal Wall and Hernia Surgery, 2020
PURPOSE: The aim of this study was to compare the effects of self-gripping mesh and prolene mesh ... more PURPOSE: The aim of this study was to compare the effects of self-gripping mesh and prolene mesh fixed with staples on postoperative pain in patients undergoing videolaparoscopic inguinal herniorrhaphy by the transabdominal preperitoneal (TAPP) technique. MATERIALS AND METHODS: The study analyzed data from 52 patients (46 males, mean age 54.9 years, 51.9% right-sided hernias) who underwent TAPP. They were operated on consecutively and randomly in two groups of 26 patients each: Group 1 with self-gripping mesh and Group 2 with endoscopic tacker-fixed prolene mesh. Each patient's postoperative pain was recorded twice using a visual analog scale (VAS) at 6 and 24 h after the surgery. Patients were followed up to 10 months after the surgery. RESULTS: The median VAS score at 6 h for all patients was 3. The median score at 24 h was 1. The median VAS scores of the two groups were different at 6 h: In Group 1, the median score was 2, whereas in Group 2, it was 3 (P = 0.053). At 24 h, there was no difference between the groups, with a median score of 1 in both (P = 0.277). CONCLUSION: There was no statistically significant difference between groups according to postoperative pain (after 6 h and after 24 h). Studies with larger samples are needed to compare self-gripping mesh with tacker fixation in laparoscopic inguinal hernia repairs. The technique performed was safe and reproducible, with a low complication rate, early patient discharge, and good postoperative recovery.
Revista do Colegio Brasileiro de Cirurgioes, Jan 26, 2018
to evaluate and compare the early postoperative period systemic inflammatory response between eld... more to evaluate and compare the early postoperative period systemic inflammatory response between elderly and non-elderly patients submitted to laparoscopic cholecystectomy, mainly performing a quantitative analysis of interleukin-6 (IL-6), a marker of inflammatory activity systemic. we compared a series of cases over a period of six months at the Gaffrée and Guinle University Hospital of the Federal University of the State of Rio de Janeiro, involving 60 patients submitted to elective laparoscopic cholecystectomy. We used non-probabilistic sampling for convenience, selecting, from the inclusion criteria, the first 30 patients aged 18-60 years, who comprised group I, and 30 patients with age equal to or greater than 60 years, who formed group II. the 60 patients involved were followed for at least 30 days after surgery and there were no complications. There was no conversion to open surgery. The values of the medians found in the IL-6 dosages for the preoperative period, three hours a...
to describe the implementation of a training program in robotic surgery and to point the General ... more to describe the implementation of a training program in robotic surgery and to point the General Surgery procedures that can be performed with advantages using the robotic platform. we conducted a retrospective analysis of data collected prospectively from the robotic surgery group in General and Colo-Retal Surgery at the Samaritan Hospital (Rio de Janeiro, Brazil), from October 2012 to December 2015. We describe the training stages and particularities. two hundred and ninety three robotic operations were performed in general surgery: 108 procedures for morbid obesity, 59 colorectal surgeries, 55 procedures in the esophago-gastric transition area, 16 cholecystectomies, 27 abdominal wall hernioplasties, 13 inguinal hernioplasties, two gastrectomies with D2 lymphadenectomy, one vagotomy, two diaphragmatic hernioplasties, four liver surgeries, two adrenalectomies, two splenectomies, one pancreatectomy and one bilio-digestive anastomosis. The complication rate was 2.4%, with no major co...
OBJETIVO: Determinar a prevalência da síndrome de dumping em uma série de casos submetidos ao byp... more OBJETIVO: Determinar a prevalência da síndrome de dumping em uma série de casos submetidos ao bypass gástrico, baseado em critérios clínicos, e caracterizar seus principais aspectos. MÉTODOS: Foi realizada uma análise dos sintomas descritos como dumping em 34 pacientes obesos mórbidos submetidos ao bypass gástrico com reconstrução em Y de Roux, por meio do preenchimento de um questionário que incluiu um sistema de escore para o diagnóstico clínico da síndrome de dumping, descrito por Sigstad. RESULTADOS: A ocorrência de dumping com base em critérios subjetivos foi de 44%. Aplicando o escore para diagnóstico clínico, a ocorrência foi de 76%. Os sintomas mais freqüentes foram "vontade de deitar" (88%), cansaço (69%) e sono (69%). Apenas 28% dos pacientes com dumping se sentiram incapacitados para a realização das atividades cotidianas. Não foi observada diferença entre o percentual de perda de peso dos pacientes dumpers e não-dumpers. CONCLUSÃO: O escore de Sigstad se mostro...
OBJETIVO: A gastrostomia, realizada para possibilitar acesso nutricional ou descompressão, é comu... more OBJETIVO: A gastrostomia, realizada para possibilitar acesso nutricional ou descompressão, é comumente realizada por via endoscópica, por radiologia intervencionista, e, mais raramente, por via cirúrgica através de videolaparoscopia ou incisão mediana supra-umbilical. Os métodos endoscópico e radiológico, apesar de estabelecidos em muitos centros, não constituem rotina em hospitais comunitários pela necessidade de pessoal qualificado e material descartável, sendo usualmente realizada a gastrostomia cirúrgica com incisão mediana e anestesia geral. A Gastrostomia de Incisão Única descrita neste trabalho é um novo método cirúrgico menos invasivo, que foi desenvolvido para ser realizado sob anestesia local, com uma única incisão e sem necessidade de equipamento especial. MÉTODO: Quinze pacientes elegíveis para gastrostomia por diferentes indicações foram operados sob anestesia local. Após incisão subcostal de 1cm sobre o músculo reto abdominal esquerdo, uma área de parede gástrica era l...
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery, Jan 21, 2018
Surgeries with single port access have been gaining ground among surgeons who seek minimally inva... more Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias. To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port. A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias. Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique. There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.
Arquivos brasileiros de cirurgia digestiva : ABCD = Brazilian archives of digestive surgery
All available treatments for achalasia are palliative and aimed to eliminate the flow resistance ... more All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied. The evaluation protocol with dysphagia scores compared preoperative, immediate (up to three months) postoperative and late (over one year) postoperative scores to estimate quality of life. The surgical procedure was Heller-Dor in 100% of cases, with 84 cases performed laparoscopically. The percent reduction in pre- and immediate postoperative lower esophageal sphincter pressurewas 60.35% in the success group and 32.49% in the failure group. Regarding the late postoperative perio...
ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo), 2015
In the surgical treatment of colorectal cancer, a lymphadenectomy is considered adequate when at ... more In the surgical treatment of colorectal cancer, a lymphadenectomy is considered adequate when at least 12 lymph nodes are removed. To evaluate whether videolaparoscopic surgery positively affects the rates of adequate lymphadenectomy. An observational study was conducted with patients undergoing either open or videolaparoscopic surgery for colorectal cancer between 2008 and 2013. The following variables were collected: gender, age, tumor site, histology, degree of differentiation, tumor stage, number of lymph nodes removed, and number of lymph nodes affected by the disease. A total of 62 patients with colorectal cancer were included; 42 (67.7%) received open surgery, and 20 (32.3%) laparoscopic surgery. Regarding lymphadenectomy, a mean of 13 lymph nodes (95% CI: 10-16) were removed in the group that received open surgery, while 19 lymph nodes were removed (95% CI: 14-24) in the laparoscopic surgery group (p=0.021). Adequate lymphadenectomy (removal of at least 12 lymph nodes) was achieved in 58.1% of the total cases, in 50.0% of the patients who received open surgery, and in 75% of those who received laparoscopic surgery. Non-elderly patients and those with an advanced disease stage were more likely to receive an adequate lymphadenectomy (p=0.004 and p=0.035, respectively). Disease stage and patient age were the factors that had the greatest influence on achieving an adequate lymphadenectomy. The type of surgery did not affect the number of lymph nodes removed.
ABSTRACT A multiclass method has been optimized and validated for the simultaneous determination ... more ABSTRACT A multiclass method has been optimized and validated for the simultaneous determination of 113 pesticides residues belonging to several classes in peanuts. It has been based on QuEChERS methodology (quick, easy, cheap, effective, rugged and safe) and ultra high performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry (UHPLC–MS/MS). Several extraction solutions were tested and the composition that showed the best results consisted of a mixture of ethyl acetate and acetonitrile. A cleanup step using dispersed phase C18 (octadecyl) and PSA (Primary and Secondary Amine) was necessary due to the high amount of oil present in the matrix. The method was validated and the parameters of validation were satisfactory. The accuracy was assessed by calculating the recovery of spiked blank samples in four concentration levels (0.010; 0.025; 0.050 and 0.100 mg/kg). The results showed satisfactory recoveries (between 70 - 120 %), except for oxamyl and tricyclazol at 0.010 mg/kg level that did not show acceptable parameters for the recovery assays. Repeatability and intermediate precision aggraded showed coefficients of variation < 20%, except for buprofenzin, etione and picolinafem at 0.100 mg/kg level. Limits of detection and quantification of the method were 0.005 and 0.010 mg/kg, respectively, except for oxamyl and tricyclazol.
To evaluate the surgical outcomes of Heller's Cardiomyotomy with Dor fundoplication by laparo... more To evaluate the surgical outcomes of Heller's Cardiomyotomy with Dor fundoplication by laparoscopy (HDL) and to assess its impact on patients' quality of life and on esophageal manometry data. 60 patients with esophageal achalasia, operated on between 2001 and 2007, were studied retrospectively. Before surgery, the demographics and the diagnostic test results were recorded. The patients submitted a dysphagia score for quality of life before and after surgery, and lower esophageal sphincter pressure (PLES) was measured. We also studied the difference produced in quality of life 37 women and 23 men were followed. Mean age was 41.08 (12-87). There was no mortality and no conversions. The mean time of diet resumption was 1.6 day. The outcome was considered excellent in 80% of the series and intermediate in 20% of the series. The mean dysphagia score before surgery was 9.03 points, and after surgery, 1.7 point (maximum of 10 points), p=0.0001. The mean score decrease between pre-...
Introduction. Laparoendoscopic single-site surgery (LESS) uses a multiple-entry portal in a singl... more Introduction. Laparoendoscopic single-site surgery (LESS) uses a multiple-entry portal in a single 3.0- to 4.0-cm incision in a natural scar, the umbilicus. The present study aimed to compare the inflammatory impact of classic video laparoscopic cholecystectomy (LC) versus LESS cholecystectomy. Methods. A prospective randomized controlled study was conducted from January to June 2011 at 2 university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients (53 women, 4 men; mean age = 48.7 years) were randomly assigned to receive LC (n = 29) or LESS (n = 28) cholecystectomy. C-reactive protein (CRP) and interleukin 6 (IL-6) were measured from blood samples collected during induction of anesthesia and at 3 and 24 hours postoperatively. Results. Median IL-6 levels in the LESS and LC groups, respectively, were 2.96 and 4.5 pg/mL preoperatively, 11.6 and 28.05 pg/mL at 3 hours postoperatively (P = .029), and 13.18 and 15.1 pg/mL at 24 hours postoperatively (P = .52). Median CRP levels in the LESS and LC groups, respectively, were 0.33 and 0.44 mg/mL preoperatively, 0.40 and 0.45 mg/mL (P = .73) at 3 hours postoperatively, and 1.7 and 1.82 mg/mL (P = .84) at 24 hours postoperatively. We did not find a significant association between IL-6 (and CRP) and body mass index in the LESS group. Conclusions. LESS cholecystectomy requires a larger size incision than LC. We found a tendency of less postoperative pain following LESS cholecystectomy than LC. There was also a tendency toward lower early inflammatory impact following LESS cholecystectomy versus LC.
Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, ... more Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0-4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complications, and postoperative pain of LESS compared with those of laparoscopic cholecystectomy (LC). A prospective randomized controlled study was conducted between January and June 2011 at two university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients were randomly assigned to undergo laparoscopic or LESS cholecystectomy. Skin and aponeurosis wound sizes were recorded. A 10-point visual analog scale (VAS) was used to assess pain at postoperative hours 3 and 24. Healing and wound complications were assessed at follow-up. A total of 57 patients, 53 women and 4 men with a mean age of 48.7 years, were randomly assigned to undergo LESS (n = 28) or LC (n = 29). The mean length of the umbilical skin incision was 4.0 cm (range = 2.1-5.8) in LESS and 2.7 cm (1.5-5.1) in LC (p < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0-5.5) in LESS and 2.3 cm (1.2-3.5) in LC (p < .0001). The mean operative time was 60.3 min (32-128) for LESS and 51.3 min (25-120) for LC (p = 0.11). Gallbladder perforation at detachment occurred in 15.69 % of the LESS cases and in 5.88 % of the LC cases (p = 0.028). The mean VAS score for pain at hour 3 was 2.0 points (0-7) for the LESS group and 4.0 (0-10) for the LC group (p = 0.07), and at postoperative hour 24 it was 0.3 points (0-6) for LESS and 2.3 (0-10) for LC (p = 0.03). There were no significant differences in wound complications. Incisional hernias were not found in either group. The LESS single-port (SP) operations demand a bigger incision than LC surgery. However, there were no differences in healing, wound infections, and hernia development. We found a tendency of less postoperative pain associated with LESS/SP than with LC.
ABSTRACT A multiresidue method for the quantification of 128 pesticides in banana is described. I... more ABSTRACT A multiresidue method for the quantification of 128 pesticides in banana is described. It involves the application of a modified QuEChERS procedure followed by UHPLC–MS/MS (Ultra High Performance Liquid Chromatography coupled to Tandem Mass Spectrometry) analysis. The method was validated according to the European Union SANCO/12495/2011 guidelines and Brazilian Manual of Analytical Quality Assurance. The validation levels were 10.0; 25.0; 50.0 and 100 μg kg−1. Acceptable values were obtained for the following parameters: linearity, limit of detection – LOD (5.00 μg kg−1) and limit of quantification – LOQ (10.0 μg kg−1), except for fenamiphos and mevinphos (LOD = 7.5 μg kg−1 and LOQ = 25 μg kg−1), trueness (for the levels: 10.0, 25.0, 50.0 and 100 μg kg−1 the recovery assays values were between 70 and 120%) except for methamidophos at 10 μg kg−1 level (67.5%), intermediate precision (<20.0%) and measurement uncertainty tests (<50.0%). These results demonstrate the applicability of this method in the routine practice by the laboratories of Ministry of Agriculture, Livestock and Food Supply of Brazil that attend the National Control Plan for Residues and Contaminants (PNCRC).
A method using QuEChERS extraction and LC-MS/MS in electrospray positive ionisation mode was deve... more A method using QuEChERS extraction and LC-MS/MS in electrospray positive ionisation mode was developed and validated for the analysis of 90 pesticides in a high water content matrix (tomato) in a single chromatographic run. To assess the intra-laboratory reproducibility of the method, validation was conducted on four different days by two different analysts. The validation data was treated using a spreadsheet developed in-house, which sets the most appropriate model for linear fit by determining whether the residuals of the calibration curves are homocedastic or heterocedastic. A statistical test for the significance of regression was also carried out. Calibration was always matrix-matched and the curves were obtained over the range 0.0075-0.10 or 0.020-0.125 mg kg(-1). Identification of analytes was based on retention times and MRM ratios. Recoveries were assessed at four different levels for each analyte and were between 73 and 106%, with relative standard deviations under reproducibility conditions of <20%. The measurement uncertainties of the method for each pesticide analysed were below 50%. Previous validation of the same method, applied to papaya samples and satisfactory results obtained in various proficiency tests with different high water content matrices, demonstrated the applicability of the method to these classes of commodities, without clean-up. The validated method will be applied routinely in the pesticide residues monitoring programme that constitutes the National Residue and Contaminant Control Plan of Brazil.
Uploads