DSpace Coleção:
http://www.repositorio.ufop.br/jspui/handle/123456789/8504
2024-03-29T14:51:10ZO uso da Indocianina Verde (ICG) em hepatectomias robóticas : uma revisão não sistemática.
http://www.repositorio.ufop.br/jspui/handle/123456789/17712
Título: O uso da Indocianina Verde (ICG) em hepatectomias robóticas : uma revisão não sistemática.
Autor(es): Siqueira, Sávio Lana; Costa, Guilherme Galvone Fonseca; Rosa, Gustavo Salman; Goulart, Igor Nunes; Torres, Marcela Gallinari da Costa; Machado, Raquel Athayde Braga
Resumo: Objetivo: O artigo tem como objetivo realizar uma revisão da literatura sobre o uso da
Indocianina Verde nas hepatectomias robóticas. O intuito do trabalho é apresentar como essa
recente técnica é executada, assim como estabelecer as vantagens que ela trás diante dos
métodos convencionais e suas limitações vigentes. Introdução: A hepatectomia é um
procedimento cirúrgico que tem se tornado cada vez mais seguro. Visando aprimorar a
navegação intraoperatória pelas estruturas tridimensionais, os procedimentos robóticos podem
ser realizados de forma guiada por fluorescência, a partir da aplicação de Indocianina verde
(ICG). Metodologia: Essa é uma revisão não sistemática que tem como base artigos científicos
publicados sobre o uso de Indocianina Verde em hepatectomias robóticas, utilizando-se os
bancos de dados LILACS, Pubmed, Scielo, com seleção de artigos publicados nos últimos 14
anos. Resultado: A aplicação da técnica intraoperatória da ICG permite a identificação e o
melhor entendimento de marcos anatômicos na cirurgia hepatobiliar: anatomia das artérias, veia
porta e ductos biliares. O uso da ICG é indicado como método de alta sensibilidade na
identificação de tumores malignos, o que aumenta a precisão da ressecção hepática e o
estadiamento cirúrgico do câncer. Conclusão: A abordagem de tumores hepáticos é complexa
e envolve inúmeras variáveis. É inegável que essa é uma técnica extremamente útil para as
cirurgias oncológicas hepáticas, sendo necessário maiores estudos e aplicabilidades para a ICG.2022-01-01T00:00:00ZEffects of clonidine, isoflurane, and the clonidine+isoflurane association in isolated hearts.
http://www.repositorio.ufop.br/jspui/handle/123456789/17711
Título: Effects of clonidine, isoflurane, and the clonidine+isoflurane association in isolated hearts.
Autor(es): Dupin, João Bosco; Alberti, Luiz Ronaldo; Zocratto, Orlando Barreto
Resumo: Background: Isoflurane has been consecrated as an anesthetic drug of choise in heart
surgeries, as it presents characteristics that ensure the preservation of cardiac indexes and
myocardial stability. Recently, alpha-adrenergic agents, mainly Clonidine, have been added to
this anesthetic arsenal in an attempt to prevent adrenergic discharges, increase cardiac
stability, reduce myocardial ischemia and improve anesthetic induction and recovery.
Objective: The aim of this study was to evaluate the cardiovascular effects of Clonidine,
Isoflurane, and Clonidine+Isoflurane association in isolated hat hearts preparations, as well as
to evaluate direct heart effects of the clonidine, possibly masked by its central action.
Method: This study used twenty four, male, albino, Wistar rats from the Biotherium of the
Federal University of Minas Gerais (UFMG). The animals were anesthetized with 100 mg of
ketamine + 10 mg of xylazine intraperitoneally, and, after a full thoracotomy, their hearts
were isolated and placed in coronary perfusion using a Krebs-Henseleit nutrient-rich solution,
according to the Langerdorff method. The parameters of Heart Rate, Systolic Blood Pressure,
Coronary Flow, and Myocardial Contractility were evaluated at times of O, 1, 2, 3, 5, 10, and
15 minutes.
Results: Heart rate – No statistically significant difference was observed among the
Clonidine, Isoflurane, Clonidine+Isoflurane, and Control groups. Systolic Blood Pressure –
No statistically significant difference was identified among the Clonidine,
Clonidine+Isoflurane, and Control groups. In the group that received only Isoflurane, the
systolic blood pressure proved to be equal to the control group and presented, on average,
18.3 more units than did the Clonidine group. In the groups that received
Clonidine+Isoflurane, the systolic blood pressure was, on average, 22.5 units less than thecontrol group and, on average, 32.7 units less than the group that received only Isoflurane.
Coronary Flow – No statistically significant difference was found regarding the coronary flow
among the Clonidine, Isoflurane, Clonidine+Isoflurane, and Control groups. Myocardial
Contractility – No statistically significant change was found in this parameter among the
Clonidine, Isoflurane, Clonidine+Isoflurane, and Control groups.
Conclusion: Clonidine, when used in an isolated manner, produced no significant effect on
the hemodynamic behavior of the isolated rat hearts. When used in association with
Isoflurane, Clonidine was capable of diminishing the effects of this drug, demonstrating an
apparent protective effect upon the heart. The observed effects occurred directly upon the
heart, considering that this study was conducted on isolated hearts, that is, with no connection
to the central nervous system.2023-01-01T00:00:00ZThe role of alpha-adrenergic agonists in the myocardial ischemia prevention.
http://www.repositorio.ufop.br/jspui/handle/123456789/17710
Título: The role of alpha-adrenergic agonists in the myocardial ischemia prevention.
Autor(es): Dupin, João Bosco; Dupin, João Henrique; Zocratto, Orlando Barreto
Resumo: The ischemia is one of the most fearsome events in the medicine. The lack of oxygen
leads to irreversible tissue damages, wherever it happens. When the affected tissue is the
myocardial, the lesion is quite severe due to the importance of the heart to the physiological
normality.
In anesthetized patients, myocardial oxygen requirements may increase beyond expected
due to surgical stress (1, 2). In spite of been anesthetized the body understands the surgery as an
aggression and it releases adrenaline. Whenever the person is attacked, the autonomous nervous
system reacts immediately and one of the side effects in this situation can be ischemia.
It is well established that an imbalance of the autonomic nervous system can be involved
in the genesis of the myocardial ischemia. Such events can have its pathophysiological
mechanism originated in the activation of the sympathetic central nervous system. The increase of
the sympathetic activity may result in ischemic events of the myocardial layer due to the
myocardial electric instability (3, 4).
The stress, mediated by the sympathetic system, is one of the worst surgical factors,
because it can activates the endocrine system and releases nor-epinephrine until two days after
surgery. Nor-epinephrine increases consumption of oxygen and glucose, reducing the organic
defenses. Such a body behavior comes before, during and after surgery.
This cascade of events can be avoided preoperatively. Many drugs as opioids, cardiac
blockers, among others, have been used in order to modulate sympathetic tone. The Sympathetic
hyperactivity may be modulated by drugs acting directly on its site of origin in the central nervous
system. Recently the alfa-2 adrenergic agonists have been used with the purpose of preventing
myocardial ischemia, because of its possibility of controlling sympathetic nervous system
discharges. The ability of alpha-2 adrenoceptor agonists to inhibit central sympathetic outflow may benefit patients with risk of myocardial damage by improve the myocardial oxygen demand
and supply ratio (5, 6).
Among these new agents, clonidine, first generation centrally acting drugs, showed a
better ability to inhibit central sympathetic outflow, improve myocardial oxygen demand and
supply ratio and also have a role in providing haemodynamic stability. Clonidine, a central alpha-
adrenoceptor agonist, decreases sympathetic outflow, increases parasympathetic tone, decreases
the rennin - angiotensin system activity and decreases vasopressin blood concentration (7- 9). As
a result, systemic arterial blood pressure is lowered, resting heart rate is decreased and exercise-
induced tachycardia is attenuated (10). Decrease in systemic arterial pressure and systemic
vascular resistance leads to a lowered myocardial wall tension (14). Clonidine also has the
capacity of modify the pain perception, which contributes to decrease oxygen consumption. These
effects would theoretically contribute to avoid or minimize the effects of myocardial ischemic
events (11).
The alpha-2 adrenoceptor agonist, clonidine, can act directly in the central nervous sys-
tem, in sites of nor-epinephrine release as the locus ceruleus. This is a tiny nucleus located in the
brainstem at the level of the fourth ventricle. In the human brain, it is readily identifiable because
of its bluish color, caused by melanin pigments (12). This brain nucleus attracted intense interest
in the last two decades, largely because of its relationship with emotional behavior. Many evi-
dences pointed this brain nucleus taking a role in emotional behavior such as wakefulness, depres-
sion, dementia of the Alzheimer type and, consequently, stress. There is, perhaps, more
knowledge about the anatomical projections and postsynaptic effects of the locus ceruleus than
any other system in brain due to the interest that wakes up about the stress mechanism. Recent
studies with radioisotopes have also revealed a homogenous set of discharge properties from its
cells and shown that specific behavioral and sensory events evoke concerted activity of its
neurons (13). The observed data lead to the suggestion that wakefulness is controlled by this
nucleus and that, clearly, this would have important implications for clinical anesthetic practice
(12).
Clonidine and others alpha-2 adrenergic agonists such as dexmedetomidine can act
directly in locus ceruleus decreasing or avoiding the nor-epinephrine release. Administration of
this drug, that is 200 times specific for the alpha-2 receptors, reduced the incidence of
perioperative myocardial ischemic episodes from 39% to 24% (6). Reduction in frequency of
coronary pains by at least 50% was observed in chronic anginous patients (14). and a big decrease
in ST-segment elevation was observed: after 24 hr (37% of initial value) and after 48 hr (30%)
measured by precordial electrocardiografic mapping (15). Clonidine was effective in reducing the
exercise-induced increases in blood pressure (20.8%) and the effort related ventricular extra systoles were reduced by greater than 50%. In patients who had been diagnosed with coronary
artery disease or who had at least two of the following five risk factors for cardiac disease: aged
60 years or older, hypertension, smoking within one year, cholesterol of 240 mg/dL or more, or
diabetes submitted a noncardiac surgery; the mortality decreases 50% at two years (16).
Finally, the results show that clonidine present cardioprotective effect and that a small oral
dose, given prophylactically, can reduce the incidence of perioperative myocardial ischemic
episodes without affecting hemodynamic stability, even in patients with documented coronary
artery disease (5).2023-01-01T00:00:00ZSchwannoma in cervicothoracic topography : an unusual case report.
http://www.repositorio.ufop.br/jspui/handle/123456789/17709
Título: Schwannoma in cervicothoracic topography : an unusual case report.
Autor(es): Zocratto, Orlando Barreto; Gomes, Ana Beatriz Campos; Cassoli, Andressa Chaves; Soares, Arthur Guimarães; Horta, Fernando Brasil de Souza; Barbosa, Gustavo Henrique de Oliveira; Oliveira, Janssen Ferreira de; Ladeira, Júlia Araújo
Resumo: O Schwannoma cervicotorácico é uma neoplasia
neurogênica benigna, a qual surge a partir das células de
Schwann da bainha de mielina de nervos fora do sistema
nervoso central. A etiologia ainda não é estabelecida e o
acometimento topográfico é variável. Estima-se que pelo
menos um quarto dos casos ocorra na região da cabeça e
do pescoço. Embora seja mais comum por volta da terceira
e quarta décadas de vida, o relato de caso em estudo
apresenta uma paciente de 17 anos, cuja sintomatologia
não foi manifestada, apesar do tamanho considerável da
lesão. Tais fatos evidenciam a atipia e relevância do caso
clínico relatado. Esse artigo, portanto, tem por objetivo
destacar a relevância do Schwannoma como diagnóstico
diferencial de massas cervicais, mesmo em pacientes jovens
e assintomáticos. Estima-se que um quarto dos casos
ocorra na região da cabeça e do pescoço.2020-01-01T00:00:00Z