283 research outputs found
Highly enantiospecific oxyfunctionalization of nonactivated hydrocarbon sites by perfluoro-cis-2-n-butyl-3-n-propyloxaziridine
No full text
Creation of pneumoperitoneum using a bladed optical trocar in morbidly obese patients: Technique and results
No full textBackground: It is advised by the manufacturer that the bladed optical trocar is to be applied only after CO2 insufflation. However, after a long experience with bladed optical trocars after CO2 insufflation in bariatric patients, we found that it is possible to enter the abdomen with this trocar prior to insufflation. This investigation was performed to test the hypothesis that this bladed technique under direct visualization before abdominal insufflation is a safe and effective method for initial trocar placement for laparoscopic bariatric procedures. Methods: Data on a series of 200 consecutive laparoscopic bariatric procedures with bladed optical access trocar were reviewed. The entry time for the optical trocar was measured in 70 patients. All the operative reports were reviewed for the following data: (1) successful initial trocar placement, (2) vascular injury during initial trocar placement, and (3) hollow viscus injury accessing the peritoneal cavity with bladed trocar. The trocar placement time was defined as the time to place the trocar into the peritoneal cavity after skin incision and was recorded in the last 70 cases. Results: There was no evidence of any vascular injury during initial trocar placement. There was no evidence of hollow viscus or organ injury during initial trocar placement. The insertion of the initial trocar was successful in all the patients. The average trocar insertion time was 20 s (range 10-50), and BMI did not affect the time of insertion. Conclusions: We think that our technique of entering the abdominal cavity via a bladed optical trocar without prior abdominal insufflation can be performed safely in morbidly obese patients. More studies and larger series are needed to validate this method. © 2008 Springer Science + Business Media, LLC
Preparação e caracterização de bentonitas modificadas e sua utilização na clarificação de óleos vegetais
No full textTese (doutorado) - Universidade Federal de Santa Catarina, Centro Tecnológico. Programa de Pós-Graduação em Engenharia QuímicaDuas amostras de argilas bentoníticas argentinas de composições mineralógicas diferentes foram ativadas com ácidos clorídrico e sulfúrico, em diferentes concentrações e tempos, com o intuito de se avaliar a influência de suas propriedades estruturais, decorrentes do tratamento ácido, sobre a clarificação de óleos vegetais. Inicialmente foi realizado um conjunto de ensaios de caracterização nas amostras em seu estado natural, o que permitiu constatar que as argilas em questão eram constituídas principalmente de argilominerais esmectíticos, contendo impurezas tais como quartzo, feldspato, caulinita e gesso. Para o estudo dos efeitos do ataque ácido nas estruturas das argilas, as amostras naturais e depois de ativadas foram caracterizadas através de análise química, difração de raios-X, análise térmica diferencial e termogravimétrica, e espectroscopia de infravermelho. Dos ensaios de clarificação de óleo, observou-se uma influência das propriedades estruturais dos produtos (argilas ativadas) sobre seu desempenho para a clarificação de óleos. As argilas ativadas apresentaram um poder de clarificação de óleos vegetais comparável ou superior ao de argilas comerciais utilizadas como referência. As argilas foram também avaliadas para outras aplicações de interesse: a) verificar seu potencial para uso como fluidos de perfuração de poços de petróleo; (b) determinar suas propriedades catalíticas para a reação de isomerização do b-pineno
Utilizzo della FT-NIRs per il monitoraggio del valore chimico-nutrizionale delle risorse foraggere di aziende transumanti alpine
No full textGeneral anesthesia via laryngeal mask airway in laparoscopic gastric banding (LAGB)
No full textBackground The use of ProSealÔ LMA (PLMA) has been reported in obese patients undergoing abdominal surgery procedures but not yet in super obese undergoing LAGB.
Methods Ten super-obese patients (mean BMI 61,7 kg/m2, range 58.3–68.5) underwent LAGB under general anesthesia with the PLMA and intravenous propofol. The conventional orogastric tube was replaced by a 14-G Salem gastric tube passed through the drainage tube of the PLMA. Outcome measures were O.R. times, surgeon evaluation of the adequacy of the anesthetic technique, and patient evaluation of postanesthesia satisfaction.
Results Mean total times in the operating room was 42 + 12 min. Immediate or intraoperative problems were encountered in one (10%) of ten patients (poor relaxation that made pneumoperitoneum more difficult). Surgeons rated analgesia as good or excellent in all ten patients and muscle relaxation as good or excellent in nine out of ten patients. Surgeons rated overall satisfaction for the anesthetic technique as good or excellent in all ten patients. Patient satisfaction with anesthetic technique was high, and all ten patients agreed or strongly agreed that they were satisfied. The awakening phase was prompt after surgery (<5 min), postoperative nausea, and vomiting was absent in all the patients, who were able to stand and walk within 1 h after completion of surgery. Conclusions General anesthesia via PLMA with intravenous propofol is safe and effective for LAGB and yields to a high degree of satisfaction for patients and surgeons
Omentopexy with Glubran®2 for reducing complications after laparoscopic sleeve gastrectomy: Results of a randomized controlled study
No full textBackground: Gastric fistulas, bleeding, and strictures are commonly reported after laparoscopic sleeve gastrectomy (LSG), that increase morbidity and hospital stay and may put the patient's life at risk. We report our prospective evaluation of application of synthetic sealant, a modified cyanoacrylate (Glubran®2), on suture rime, associated with omentopexy, to identify results on LSG-related complications. Methods: Patients were enrolled for LSG by two Bariatric Centers, with high-level activity volume. Intraoperative recorded parameters were: operative time, estimated intraoperative bleeding, conversion rate. We prospectively evaluated the presence of early complications after LSG during the follow up period. Overall complications were analyzed. Perioperative data and weight loss were also evaluated. A control group was identified for the study. Results: Group A (treated with omentopexy with Glubran®2) included 96 cases. Control group included 90 consecutive patients. There were no differences among group in terms of age, sex and Body Mass Index (BMI). No patient was lost to follow-up for both groups. Overall complication rate was significantly reduced in Group A. Mean operative time and estimated bleeding did not differ from control group. We observed three postoperative leaks in Group B, while no case in Group A (not statistical significancy). We did not observe any mortality, neither reoperation. Weight loss of the cohort was similar among groups. In our series, no leaks occurred applying omentopexy with Glubran®2. Conclusion: Our experience of omentopexy with a modified cyanoacrylate sealant may lead to a standardized and reproducible approach that can be safeguard for long LSG-suture rime. Trial registration: Retrospective registration on clinicaltrials.gov PRS, with TRN NCT03833232 (14/02/2019)
Laparoscopic gastric rebanding for slippage with pouch dilation: Results on 29 consecutive patients
No full textBackground: Laparoscopic adjustable gastric banding (LAGB) slippage with pouch dilation is one the most serious long-term complications and requires reoperation in most cases. It is still controversial whether banding should be offered again or a different procedure should be chosen. We report the results of synchronous de-rebanding on a prospective series of patients treated at our institution for slippage with pouch dilation. Methods: From January 2000 to May 2007, 29 consecutive patients underwent laparoscopic de-rebanding for slippage with pouch dilation. The mean age at primary operation was 38.9±8.2 years and the mean BMI was 46.4±8 kg/m2. Twenty-eight had previous LAGB, while one had previous open gastric banding, the perigastric technique being used at that time. All the redo procedures were successfully carried out under laparoscopy, via the pars flaccida technique, and all the patients were followed-up according to the usual schedule. Results: The mean time from the original LAGB was 45.3±30.3 months, and the mean follow-up after rebanding was 26.9±20.6 months. At rebanding, the mean BMI was 34.3±7.6, percent excess weight loss (%EWL) 54.5±31, and percent excess BMI loss (ëL) 58.3±33, respectively. After 1 year, BMI was 36.3±7.9, %EWL 40.8±30.5, and ëL 43.9±32.7, respectively. After 2 years, BMI was 37.13±7.4, %EWL 36.9±29.4, and ëL 39.6±31.6, respectively, and after 3 years, BMI was 33.5±5.6, %EWL 51.9±24.3, and ëL 55.7±25.7, respectively. One patient had re-rebanding after 6 months for a new slippage, two had band removal with refusal to switch to another procedure, one had biliopancreatic diversion for slippage recurrence, and one underwent sleeve gastrectomy for insufficient weight loss after 6 months. Conclusions: Although this is a limited series, our results show that good outcomes can be expected after rebanding in properly assessed patients with slippage and pouch dilation. Larger series and longer follow-up are needed to confirm these findings. © 2008 Springer Science + Business Media, LLC
Hemodynamic and Hormonal Stress Responses to Endotracheal Tube and ProSeal Laryngeal Mask Airway TM for Laparoscopic Gastric Banding.
No full textBACKGROUND: The stress responses from tracheal intubation are potentially dangerous in patients with higher cardiovascular risk, such as obese patients. The primary outcome objective of this study was to test whether, in comparison with the endotracheal tube (ETT), the ProsealTM Laryngeal Mask Airway (PLMATM) (Laryngeal Mask Airway Company, Jersey, United Kingdom) reduces blood pressure and norepinephrine responses and the amounts of muscle relaxants needed in obese patients. METHODS: We assessed hemodynamic and hormonal stress responses, ventilation, and postoperative recovery in 75 morbidly obese patients randomized to receive standardized anesthesia with either an ETT or the PLMATM for laparoscopic gastric banding. RESULTS: In repeated-measures ANOVA, mean arterial blood pressure and plasma norepinephrine were significantly higher in the ETT group than in the PLMATM group. In individual pairwise comparisons, blood pressure rose higher in ETT than PLMATM patients after insertion and removal of airway devices, and after recovery. In ETT compared with PLMATM patients, plasma norepinephrine was higher after induction of carboperitoneum (mean ± SD, 534 ± 198 and 368 ± 147 and pg/ml, P = 0.001), after airway device removal (578 ± 285 and 329 ± 128 pg/ml, P < 0.0001), and after recovery in postanesthesia care unit (380 ± 167 and 262 ± 95 and pg/ml, P = 0.003). Compared with use of the ETT, the PLMATM reduced cisatracurium requirement, oxygen desaturation, and time to discharge from both the postanesthesia care unit and the hospital. CONCLUSIONS: PLMATM reduces stress responses and postoperative complaints after laparoscopic gastric banding
Management of cutaneous melanoma MO: state of the art and trends.
No full textThis article reviews the epidemiology, diagnosis and treatment of cutaneous melanoma, including the most recent developments. The combination of positive family history, fair complexion, number of nevi, exposure to sun and/or chromosomal alterations seem to be implicated in the pathogenesis of cutaneous melanoma. Melanomas can be classified according to their growth patterns, and tumour microstaging is of straightforward predictive value for survival and risk of metastasis, although new factors are also being investigated. As yet, surgical excision is the only effective treatment available for primary tumours, resection margins varying according to tumour thickness. Elective node dissection is, however, no longer advocated for melanomas thinner than 1.5 mm, and there is disagreement as to its role for thicker lesions. In contrast, selective node dissection at the time of definitive surgery is becoming more widely accepted, with regional node dissection being restricted to positive cases. Therapeutic dissection is required for lymph node involvement, the most common pattern of recurrence from melanoma, which affects nearly 30% of all patients. Complete remission rates from isolated limb perfusion, which has been employed in patients with multiple recurrences or in-transit metastases, range from 40 to 90%, depending on drugs and techniques used in different series; the best responses so far have been obtained with tumour necrosis factor in combination with melphalan. Patients with thick lesions (> 4mm) or lymph node metastases have a high risk of micrometastases that would warrant adjuvant therapy. The only agent found to affect survival is interferon alpha-2
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