Perioperative management of drugs commonly used in patients with rheumatic diseases: a review

Rheumatic diseases are very prevalent, affecting about 7 million people in North America; they affect the musculoskeletal system, often with systemic involvement and potential for serious consequences and limitation on quality of life. Clinical treatment is usually long-term and includes drugs that are considered either simple or complex and are occasionally unknown to many health professionals who do not know how to manage these patients in emergency units and surgical wards. Thus, it is important for clinicians, surgeons and anesthesiologists who are involved with rheumatic patients undergoing surgery to know the basic principles of therapy and perioperative management. This study aims to do a review of the perioperative management of the most commonly used drugs in rheumatologic patients. Manuscripts used in this review were identified by surveying MEDLINE, LILACS, EMBASE, and COCHRANE databases and included studies containing i) the perioperative management of commonly used drugs in patients with rheumatic diseases: and ii) rheumatic diseases. They are didactically discussed according to the mechanism of action and pharmacokinetics; and perioperative management. In total, 259 articles related to the topic were identified. Every medical professional should be aware of the types of drugs that are appropriate for continuous use and should know the various effects of these drugs before indicating surgery or assisting a rheumatic patient postoperatively. This information could prevent possible complications that could affect a wide range of patients

Revisão sistemática sobre alotransplantes de ilhotas de Langerhans em roedores: análise de sítio de transplante e tempo de sobrevida

Introdução. A escassez de ilhotas é uma restrição importante ao uso de ilhotas pancreáticas para o desenvolvimento do alotransplante para o tratamento do diabetes tipo I. É necessário, portanto, desenvolver fonte ilimitada de células produtoras de insulina. Objetivos. Organizar e analisar dados sobre o sítio de transplante e o tempo de sobrevida relacionados a tentativas experimentais de alotransplante em roedores, a fim de permitir elaborar um modelo mais adequado para suprir a escassez de doadores de ilhotas. Metodologia. Realizamos uma revisão sistemática usando o banco de dados Pubmed para pesquisar artigos publicados que contenham as palavras-chaves “rodent islet transplantation”. Foram incluídos estudos envolvendo experimentos alotransplante de ilhotas de roedores e analisadas as listas de referências das publicações recuperadas. Artigos relacionados a isotransplantes, autotransplantes e xenotransplantes foram excluídos do estudo. Resultados. Um total de 30 estudos relacionados a alotransplantes em diferentes sítios de enxerto foram selecionados para a revisão sistemática baseados na relevância de seus dados e em sua atualização. O fígado e a cápsula renal são sítios que possibilitaram uma maior sobrevida das ilhotas transplantadas. Conclusão. O alotransplante em roedores é promissor e continua a se desenvolver em diversos centros. As taxas de sobrevivência de aloenxertos aumentaram com a utilização de diferentes medicamentos e locais de enxerto.Introduction. The scarcity of islets is an important use of pancreatic islets for the development of allograft for the treatment of diabetes type I. It is therefore necessary to develop unlimited source of insulin-producing cells restriction. Objectives. Organize and analyze parameters related to the site of transplantation and survival time related to experimental rodent allotransplantation attempts in order to allow the elaboration of the most suitable model to supply the scarcity of islet donors. Methodology. We performed a systematic review using the PubMed database to search published articles containing the keywords “rodent islet transplantation”. We included studies involving allotransplantation experiments with rodents’ islets and we reviewed the reference lists of the publications retrieved that were eligible. We excluded articles related to isotransplantation, autotransplantation and xenotransplantation such as transplantation in other species. Articles related to isotransplantations, transplantations and xenografts were excluded from the study. Results. A total of 30 related allografts in different sites of graft studies were selected for the systematic review based on their relevance data and update. The liver and the kidney capsule are sites that showed better survival of transplanted islets. Conclusion. Allograft transplantation in rodents is promising and continues to develop in several centers. The allograft survival rates increased with the use of different drugs and graft sites

Medicações comumente utilizadas em pacientes com doenças reumatológicas - orientações para utilização e suspensão no período peri-operatório

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TEP for incarcerated groin hernias: is it feasible for experienced surgeons?

Objective: To verify if endoscopic TEP surgery performed by an experienced surgeon is a feasible procedure to treat incarcerated groin hernia.Methods: This is a retrospective study in which we analyzed data from patients submitted to TEP endoscopic surgery for treatment of incarcerated and non-incarcerated groin hernias. The surgeries were all performed by a single surgeon. We obtained data on gender, age, ASA scores, BMI, hernia site and operating time. The two groups were descriptively analyzed and statistically compared in order to verify how similar the samples were. The operative times were also compared between the groups. The first 65 surgeries were excluded in order to evaluate the hability of an experienced surgeon.Results: 323 surgeries were performed. 32 (9.9%) were cases of incarcerated hernias. In 306 cases (96%), the surgical approach used was TEP, the other 13 cases (4%) were operated by TAPP. All incarcerated hernias were operated by the TEP method. No significant differences on gender, age, hernia site, BMI and ASA score were found between incarcerated and non-incarcerated hernia patients. The operative time was analyzed by site of hernias (left, right and bilateral) and no statistical differences were found between incarcerated and nonincarcerated hernias.Conclusions: 1) There was no significant differences on gender, age, ASA, BMI and site of hernias that could interfere in operative time in both groups. 2) The lack of significant statistical difference on operative time indicate that, for experienced surgeons, the technical difficulty is similar to operate incarcerated and non-incarcerated groin hernias by TEP.Keywords: Herniorraphy; Inguinal hernia; Endoscopy; Learning curve; Operative time

“Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP)”: description of a project of music, management, communication and relationship of medical students of “Faculdade de Medicina da Universidade de São Paulo”

Recently there has been an important discussion about the training of medical students from medical colleges. Humanization is an aspect that influences the formation of a medical professional with the ability to deal with human beings.Students of the Faculty of Medicine, University of São Paulo (USP) interested in music came together and formed a group that performs in a musical recital. Thus was created the Recital Students of Medicine, University of São Paulo (REMUSP). Members of REMUSP perform musical rehearsalsat the Theatre, Faculty of Medicine, USP, four to five hours per week, approximately, organized through Facebook groups and e-mail. In 2011, during their first presentation, members of the REMUSP performed predominantly classic style and popular as: Canon In D - Johann Pachelbel, Ave Maria - JohannSebastian Bach, Solfeggietto - CPE Bach, Can You Feel The Love Tonight? - Elton John, New York, New York - Frank Sinatra, Kiss From a Rose - Seal etc. Currently, the demand REMUSP stimulate cooperatively and organization in musical performances, and musical rehearsals are increasingly filled by pieces to be played by a group, at the expense of the individual, aiming at integration and improvement of communication and organization of a musical group composed of future doctors more humanized.Recentemente tem se discutido muito sobre a formação médica dos acadêmicos das faculdades de medicina. A humanizaçãoé um aspecto que influencia a formação de um profissional médico com aptidão para lidar com seres humanos. Estudantes da Faculdade de Medicina da Universidade de São Paulo (FMUSP) com interesse em música se reuniram e formaram um grupo que realiza apresentações musicais em um recital. Assim foi criado o Recital dos Estudantes de Medicina da Universidade de São Paulo (REMUSP). Os membros do REMUSP realizam ensaios no Teatro da Faculdade de Medicina da USP de quatro a cinco horas por semana, aproximadamente, organizados através de grupos de Facebook e e-mail. No ano de 2011, durante a sua primeira apresentação, os membros do REMUSP executaram peças predominantemente do estilo clássico e popular, como: Canon In D – Johann Pachelbel, Ave Maria – Johann SebastianBach, Solfeggietto – C.P.E. Bach, Can You Feel The Love Tonight? – Elton John, New York, New York – Frank Sinatra, Kiss From a Rose – Seal etc. Atualmente, o REMUSP procura estimular a cooperatividade e organização nas apresentações musicais, sendo que os ensaios são cada vez mais preenchidos por peças tocadas em conjuntos, em detrimento das individuais, visando à integração e ao aperfeiçoamento da comunicação e organização de um grupo musical composto por futuros médicos mais humanizados

Chemical components separation with the use of botulinum toxin A: a critical review for correction of ventral hernia

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in abdominal wall musculature. Failure of surgical correction may lead to a more morbid treatment, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of botulinum toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical ventral hernias corrections.Methods: Using the PubMed database, the keywords ‘ventral hernia’, and ‘botulinum toxin’ were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing its length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications.Conclusion: The use of BTA seems to be a promising alternative in the management of ventral hernias due to its capacity of reducing tension in the abdominal wall. However, more studies are necessary to determine the efficacy of this method

A simple technique can reduce cardiopulmonary bypass use during lung transplantation

Cardiopulmonary bypass causes an inflammatory response and consumption of coagulation factors, increasing the risk of bleeding and neurological and renal complications. Its use during lung transplantation may be due to pulmonary hypertension or associated cardiac defects or just for better exposure of the pulmonary hilum. We describe a simple technique, or open pericardium retraction, to improve hilar exposure by lifting the heart by upward retraction of the pericardial sac. This technique permits lung transplantation without cardiopulmonary bypass when bypass use is recommended only for better exposure

Acute esophageal necrosis secondary to stent: case report of the first surviving patient.

A necrose esofágica aguda é uma das mais graves complicações associadas ao tratamento endovascular da aorta descendente com colocação de endoprótese. Sua ocorrência é rara, com apenas 3 casos descritos na literatura, entretanto em todos a complicação mostrou-se fatal. O presente trabalho descreve, até onde se sabe, o primeiro caso de necrose esofágica aguda secundária a endoprótese de aorta na qual o paciente sobrevive. Paciente masculino de 53 anos com dissecção de aorta, de artéria subclávia esquerda até bifurcação de artérias ilíacas, realizou tratamento endovascular de colocação de endoprótese. Evoluiu com lesão isquêmica de esôfago médio e distal, para a qual foi indicada esofagectomia total. Após um ano e dois meses, foi submetido a esofagogastroplastia para reconstrução do trato gastrointestinal, com transposição de tubo gástrico retroesternal, a partir da qual permanece praticamente oligossintomático. O presente trabalho consiste no primeiro relato de caso na qual o paciente sobreviveu à necrose esofágica aguda secundária à colocação de endoprótese de aorta torácica.Acute esophageal necrosis is one of the most serious complications associated with endovascular treatment of the descending aorta with stent placement. Its occurrence is rare, with only three cases reported in the literature. However, all this complication proved fatal in all cases. This paper describes, as far as we know, the first case of acute esophageal necrosis secondary to aortic stent graft in which the patient survives. 53 year old male patient with aortic dissection from the left subclavian artery to the bifurcation of the iliac arteries. Patient was submitted to endovascular stent treatment. The patient evolved with ischemic lesion of the middle and distal esophagus and total esophagectomy with gastrostomy and esophagostomy was performed for treatment. After a year and two months, patient underwent esophagogastroplasty for reconstruction of the gastrointestinal tract, with transposition of retrosternal gastric tube, from which remains virtually asymptomatic. The present case report is the first one in which the patient survived a esophagus necrosis secondary to endovascular stent treatment for thoracic aorta dissection