Ultrasound assessment of deep fascia sliding mobility in vivo: a scoping review

Introdução: A falha do deslizamento fascial pode ocorrer em casos de uso excessivo ou inadequado, trauma ou cirurgia, resultando em inflamação local, dor, sensibilização e potencial disfunção. As propriedades mecânicas dos tecidos fasciais, incluindo a sua mobilidade, têm sido avaliadas in vivo através de ecografia. No entanto, este parece ser um método que ainda não está devidamente padronizado nem validado. Objetivos: Identificar, sintetizar e comparar os princípios metodológicos da investigação científica que utilizou a avaliação ecográfica do deslizamento da fáscia profunda em humanos in vivo, e avaliar a sua fiabilidade. Métodos: Realizou-se uma pesquisa sistemática da literatura nas bases de dados ScienceDirect, PubMed (Medline), Web of Science e B-On, de acordo com as diretrizes PRISMA Extension for Scoping Reviews (PRISMA-ScR). A revisão seguiu três etapas principais: (1) identificação da questão e da literatura relevante; (2) seleção da literatura; e (3) agrupamento, mapeamento e resumo dos dados. Critérios de elegibilidade: Foram incluídos os artigos que usaram a ecografia para avaliar o deslizamento da fáscia profunda em seres humanos in vivo, usando o termo “sliding” ou outro com significado semelhante. Foram excluídos os estudos: não disponíveis em publicações revistas por partes, não disponíveis em inglês, português ou espanhol ou cujo texto completo não se encontrava acessível. Resultados: De um total de 104 artigos completos avaliados para elegibilidade, foram incluídos 18 artigos que avaliaram as fáscias profundas das regiões toracolombar (n=4), abdominal (n=7), femoral (n=4) e crural (n=3). Estes estudos abordaram questões de diagnóstico (n=11) e benefícios terapêuticos (n=7) e apresentaram níveis de evidência entre II e IV. Foram usados vários termos para descrever as medidas de resultados correspondentes ao deslizamento fascial. Foram usados diversos posicionamentos dos participantes, procedimentos para induzir o deslizamento fascial e características dos dispositivos de ecografia. Os métodos de análise do deslizamento fascial incluíram a comparação de imagens ecográficas inicial (estado de repouso) e final (estado alvo) e o uso de técnicas de software de correlação-cruzada através de algoritmos de rastreamento automatizado. Estes métodos mostraram-se fiáveis para medir o deslizamento entre a fáscia toracolombar, as junções músculo-fasciais do transverso abdominal, a fáscia lata e a fáscia crural e as fáscias epimisiais adjacentes. No entanto, os artigos incluídos apresentaram terminologias, questões de investigação, populações participantes e metodologias heterogéneas. É escassa a investigação de alta qualidade para determinar a fiabilidade dos métodos atuais para analisar outras fáscias e avaliar a influência da idade, de características relacionadas com o género, composição corporal ou condições clínicas específicas nas medidas de deslizamento fascial. Conclusão: Os métodos ecográficos de medição do deslizamento fascial incluem a comparação entre frames inicial e final de uma gravação de vídeo de ultrassom e a análise de relação cruzada através de algoritmos de rastreamento automatizado. Estes métodos parecem ser fiáveis para medir o deslizamento de algumas fáscias, mas é necessária literatura para confirmar a sua fiabilidade para outras. Além disso, são necessários protocolos de avaliação específicos e padronizados para cada região anatómica, de modo que a avaliação ecográfica do deslizamento fascial in vivo possa ser usada adequadamente na investigação e na prática clínica

Modified pectoral nerve block versus bi-level erector spinae plane block for postoperative analgesia after radical mastectomy surgery: a prospective, randomized, controlled trial

Background Regional anesthesia techniques constitute an important part of successful analgesia strategies in the perioperative care of patients undergoing breast surgery. The advent of ultrasound-guided regional anesthesia has led to the development of fascial plane blocks. The large array of blocks available for postoperative analgesia in breast surgery has increased the accessibility of regional anesthesia but has also created a dilemma of choice. This study compared the analgesic efficacy of the ultrasound-guided modified pectoral nerve (PECS) block and erector spinae plane block (ESPB) in patients undergoing radical mastectomy. Methods Seventy women were enrolled in this prospective, double-blind, randomized control trial. After exclusion, 67 female patients who underwent radical mastectomy were finally analyzed. Ultrasound-guided PECS blocks and ESPBs were performed with 30 ml 0.25% bupivacaine. Postoperative morphine and pain scores were compared between the groups. Results Postoperative total morphine consumption in the first 24 h was significantly higher in the PECS group (P < 0.001). The ESPB group exhibited significantly reduced morphine consumption at all postoperative time points. Numeric rating scale scores were lower in the ESPB group at 6, 12, and 24 h postoperatively at rest and when coughing. Conclusions Ultrasound-guided bi-level ESPBs provided better postoperative analgesia than PECS blocks after radical mastectomy surgery

Medical Robotics

The first generation of surgical robots are already being installed in a number of operating rooms around the world. Robotics is being introduced to medicine because it allows for unprecedented control and precision of surgical instruments in minimally invasive procedures. So far, robots have been used to position an endoscope, perform gallbladder surgery and correct gastroesophogeal reflux and heartburn. The ultimate goal of the robotic surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. The use of robotics in surgery will expand over the next decades without any doubt. Minimally Invasive Surgery (MIS) is a revolutionary approach in surgery. In MIS, the operation is performed with instruments and viewing equipment inserted into the body through small incisions created by the surgeon, in contrast to open surgery with large incisions. This minimizes surgical trauma and damage to healthy tissue, resulting in shorter patient recovery time. The aim of this book is to provide an overview of the state-of-art, to present new ideas, original results and practical experiences in this expanding area. Nevertheless, many chapters in the book concern advanced research on this growing area. The book provides critical analysis of clinical trials, assessment of the benefits and risks of the application of these technologies. This book is certainly a small sample of the research activity on Medical Robotics going on around the globe as you read it, but it surely covers a good deal of what has been done in the field recently, and as such it works as a valuable source for researchers interested in the involved subjects, whether they are currently “medical roboticists” or not

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Breast Cancer and Breast Reconstruction

This book has been contrived to gather recent data on a common health problem. As breast cancer imposes a heavy burden for society due to its psychological, social and economic consequences, every step to broaden our understanding is a worthy task. The aim of this book is to provide some insights on this subject through the information given on new perspectives in genetics and diagnosis, exposed in the section on oncologic issues, as well as on recent topics on surgical treatment, presented in the sections on breast conservative and breast reconstructive surgery