Lisieux Eyer de Jesus - Academia.edu (original) (raw)
Papers by Lisieux Eyer de Jesus
Journal of Pediatric Surgery, 2024
Introduction: Ileal obstruction caused by thick meconium associated with functional immaturity (I... more Introduction: Ileal obstruction caused by thick meconium associated with functional immaturity (IOMFI) is an uncommon disease associated with prematurity. IOMFI is not well known, and late or wrong diagnosis is a problem. In this research, we review the clinical characteristics and therapeutic methods of IOMFI.
Methods: Critical descriptive literature review.
Results: Most patients eliminate meconium previously to IOMFI. More premature babies tend to become symptomatic in their second week of life, with progressive abdominal distension. The most frequent complication is perforation. Radiologically there is diffuse intestinal distention without air-fluid levels. In contrast enema a caliber transition zone is observed in the distal ileum with multiple filling defects in the ileum and colon. Neural ganglia are present in biopsies from the rectum, colon, and stoma, mostly with characteristics of immature ganglia. Most patients respond to treatment with water soluble contrast enemas. Surgery is needed for patients who do not respond to enemas and those presenting perforations.
Discussion: IOMFI literature is limited to retrospective mainly small and heterogeneous cohorts. Patients usually respond promptly to water soluble enemas, but a favorable response is highly dependent in contrast reflux through the ileocecal valve and success is related to early treatment. Contrast inflow may be controlled by intermittent radiographies or real time ultrasound.
Revista CIPERJ, 2024
INTRODUCTION: Bilateral nodular adrenal hypertrophy (NBAH) is a rare genetically-determined disea... more INTRODUCTION: Bilateral nodular adrenal hypertrophy (NBAH) is a rare genetically-determined disease, presenting as ACTH-independent hypercortisolism. Three different presentations are known (macronodular, isolated micronodular, and pigmentary micronodular, all of which may show in isolated, familiar or syndromic forms. Treatment relies on bilateral adrenalectomy.
METHODS: Case report.
RESULTS: 10 years-old female with a one year history of Cushing syndrome. After investigation, ACTH-independent hypercortisolism, normal cranial image exams, and bilateral nodular adrenal hypertrophy were demonstrated. She was genetically tested, with the diagnosis of pigmentary nodular bilateral adrenal hyperplasia (PRKAR1A stop codon variant). The patient was submitted to a bilateral laparoscopic adrenalectomy, and being treated with corticosteroids and mineralocorticoids (physiologic doses), without complications. The patient has been followed up for 1 year. Her symptoms regressed, except for short height.
DISCUSSION: NBAH, described in 1964, causes < 2% of the cases of hypercortisolism. Image exams show bilateral augmented and diffusely nodular adrenal glands. In children familiar and syndromic forms are frequent. Micronodular pigmentary NBAH shows scattered hypodense micronodules on CT, without significant augmented dimensions of the adrenal glands and typically affects young adults. Treatment demands bilateral adrenalectomy, but extensive research to find effective pharmachological treatments is in course.
Revista CIPERJ, 2024
INTRODUÇÃO: cirurgias para de ampliação vesical são frequentemente indicadas em portadores de bex... more INTRODUÇÃO: cirurgias para de ampliação vesical são frequentemente indicadas em portadores de bexiga neuropática. Cateterismo vesical intermitente limpo trans-uretral pode ser difícil para pacientes femininas, em especial se cadeirantes. A construção de um conduto cateterizável continente facilita o cateterismo e aumenta a chance de independência do paciente para o auto-cuidado. Muitos pacientes apresentam também constipação crônica refratária, que pode ser tratada com lavagens colônicas anterógradas nos casos mais graves. A construção de condutos cecais cateterizáveis ou cecostomias com button facilitam o procedimento. Em alguns casos constipação crônica grave porolongada induz megasigmóide secundário, com piora progressiva da constipação e risco de volvo de sigmoide. Neste artigo discutimos o processo de escolha e execução de uma ampliação vesical em uma paciente apresentando variações anatômicas que obrigaram a equipe cirúrgica ao uso de alternativas técnicas pouco usuais.
MATERIAL E MÉTODOS: relato de caso
RESULTADOS: Paciente feminina, 9 anos, hidrocefalia valvulada, spina bífida lombar, obesidade e malformação grave das duas mãos e antebraços, cadeirante, indicação de ampliação vesical e construção de conduto urinário cateterizável continente. O inventário de cavidade revelou (1) mesentério do intestino delgado curto; (2) apêndice rudimentar; (3) megasigmóide de grandes dimensões. A equipe cirúrgica optou por (1) Ampliação vesical com sigmoide; (2) Construção de um conduto cateterizável a partir de retalho vascularizado baseado na borda mesentérica do sigmoide e (3) Apendicectomia e construção de cecostomia com cateter. A paciente evoluiu sem complicações. Passou a apresentar evacuações diárias espontâneas. Após 5 meses encontra-se continente, CIL sem dificuldades através do conduto cateterizável.
DISCUSSÃO: Através de variações e múltiplos conceitos embasados em literatura, foi escolhido um tratamento customizado para esta paciente e suas características fisiopatológicas incomuns. Há um papel de causalidade do megasigmóide na manutenção de quadros de constipação grave, que pode ser tratada com sigmoidectomia. A necessidade de preparo de cólon para a realização de cirurgias que envolvem anastomoses colônicas tem sido questionada. Várias metanálises têm sugerido que o preparo formal de cólon deve ser evitado.
Journal of Pediatric Surgery Open
Journal of Pediatric Urology, Aug 1, 2022
Journal of Pediatric Urology, Oct 1, 2012
A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with ... more A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with high inflammatory markers (C reactive protein and erythrocyte sedimentation rate). Biopsies of the testes and epididymides showed bilateral epididymal and testicular granulomata, testicular fibrosis and chronic inflammatory infiltration, and the histological diagnosis was granulomatous orchitis. The symptoms receded with oral corticosteroids. Although rare, granulomatous orchitis is a possible diagnosis in children presenting testicular enlargement. It is important to differentiate it from testicular tumors (if necessary with testicular biopsy) and to investigate its association with systemic vasculitis and infectious diseases.
Revista Paulista de Pediatria, Sep 1, 2015
Objective: To describe an adolescent with pathologic aerophagia, a rare condition caused by exces... more Objective: To describe an adolescent with pathologic aerophagia, a rare condition caused by excessive and inappropriate swallowing of air and to review its treatment and differential diagnoses. Case description: An 11-year-old mentally impaired blind girl presenting serious behavior problems and severe developmental delay with abdominal distension from the last 8 months. Her past history included a Nissen fundoplication. Abdominal CT and abdominal radiographs showed diffuse gas distension of the small bowel and colon. Hirschsprung's disease was excluded. The distention was minimal at the moment the child awoke and maximal at evening, and persisted after control of constipation. Audible repetitive and frequent movements of air swallowing were observed. The diagnosis of pathologic aerophagia associated to obsessive-compulsive disorder and developmental delay was made, but pharmacological treatment was unsuccessful. The patient was submitted to an endoscopic gastrostomy, permanently opened and elevated relative to the stomach. The distention was resolved, while maintaining oral nutrition. Comments: Pathologic aerophagia is a rare self-limiting condition in normal children exposed to high levels of stress and may be a persisting problem in children with psychiatric or neurologic disease. In this last group, the disease may cause serious complications. Pharmacological and behavioral treatments are ill-defined. Severe cases may demand surgical strategies, mainly decompressive gastrostomy.
World Journal of Urology, Dec 9, 2012
Objective Abnormal uroflowmetries are common after tubularized incised plate urethroplasties (TIP... more Objective Abnormal uroflowmetries are common after tubularized incised plate urethroplasties (TIP), perhaps due to low compliance. We hypothesized that (1) abnormal uroflowmetries after TIP might be caused by segmental lower compliance; (2) by adding a graft to the raw area in the incised plate (TIPG), compliance might be improved by preventing secondary intention healing of the dorsal incision. Methods A standardized penectomy was performed in 27 adult male rabbits: 9 normal non-operated controls (G1), 6 weeks after TIP (G2: n = 9) or TIPG (G3: n = 9).
![Research paper thumbnail of [Surgeons training: today as always?]](https://attachments.academia-assets.com/110015947/thumbnails/1.jpg)
](PubMed, Dec 1, 2009
This paper proposes to discuss the training methodologies for young surgeons, considering the mod... more This paper proposes to discuss the training methodologies for young surgeons, considering the modern needs, by discussing their expectations and the reality of the surgeons' job market nowadays. Scientific and technological novelties, the huge amount of information imposed daily, managerial interventions and cost issues modified radically the activities of the surgeons, especially if compared to classical conceptions. Recent re-readings of the classical ethical postulates demand a new behavior of the doctors concerning the patients and the society per se. Contemporaneous social culture bring about individual expectations concerning quality of life and professional perspective issues. It becomes necessary to modify the training methods for surgeons to make them adequate to the need of continuous learning and adaptation to new technological instruments. They also should adapt to social interactions with the patients and the other health professionals that fit nowadays expectations. Those structural adaptations are fundamental to maintain the interest of the new professionals in the area of surgery.
Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysrap... more Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysraphism. Description: We treated a 2 month-old boy presenting with an extensive lumbosacral deformity, hydrocephalus and apparent enteric segments in the dorsal midline, accompanied by an enteric fistula and imperforated anus. The malformation was diagnosed as split notochord syndrome. The baby died as a result of sepsis before surgical treatment could be attempted. Comments: Split notochord syndrome is the rarest form of neuroenteric cyst described until this moment (<25 cases in the literature). It is frequently associated with anorectal malformation, intestinal fistulae and hydrocephalus. Prognosis is not necessarily poor and survival is possible if digestive malformations, hydrocephalus and the dysraphism itself are treated simultaneously.
Revista do Colégio Brasileiro de Cirurgiões, Apr 1, 2012
Objetivo: Verificar o estado da arte no tratamento dos refluxos vesicoureterais (RVU) persistente... more Objetivo: Verificar o estado da arte no tratamento dos refluxos vesicoureterais (RVU) persistentes alem da infância. Metodos: Revisao de literatura. Resultados: Foram revisados os dados de literatura com relacao ao tratamento e as complicacoes do refluxo vesicoureteral persistente no adolescente e no adulto. Conclusao: Nao ha dados que permitam aconselhar o tratamento intervencionista (cirurgico ou endoscopico) do refluxo vesicoureteral no adolescente e adulto, exceto em pacientes com lombalgia secundaria a doenca e infeccao urinaria (ITU) febril recorrente mesmo com tratamento clinico correto. A cirurgia aumenta o risco de complicacoes obstetricas urologicas obstrutivas sem modificar outras variaveis obstetricas, que sao primariamente determinadas pela presenca de cicatrizes renais e pela maior susceptibilidade a infeccoes urinarias, independente da presenca de RVU em atividade. Nao ha dados disponiveis para analisar as consequencias clinicas tardias do tratamento endoscopico do RV...
Springer eBooks, Dec 1, 2021
Jornal de Pediatria, 2004
Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysrap... more Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysraphism. Description: We treated a 2 month-old boy presenting with an extensive lumbosacral deformity, hydrocephalus and apparent enteric segments in the dorsal midline, accompanied by an enteric fistula and imperforated anus. The malformation was diagnosed as split notochord syndrome. The baby died as a result of sepsis before surgical treatment could be attempted. Comments: Split notochord syndrome is the rarest form of neuroenteric cyst described until this moment (< 25 cases in the literature). It is frequently associated with anorectal malformation, intestinal fistulae and hydrocephalus. Prognosis is not necessarily poor and survival is possible if digestive malformations, hydrocephalus and the dysraphism itself are treated simultaneously.
Cadernos de Saúde Pública
Nesta pesquisa, estudamos os custos de transporte por consulta ambulatorial em pacientes referenc... more Nesta pesquisa, estudamos os custos de transporte por consulta ambulatorial em pacientes referenciados para avaliação cirúrgica especializada em um hospital terciário no Rio de Janeiro, Brasil. Trata-se de um estudo descritivo com responsáveis por pacientes pediátricos agendados para consulta de cirurgia pediátrica, questionando fatores ligados ao custo de transporte e de oportunidade (perda de remuneração, alimentação, pagamento de cuidadores para outros filhos, despesas para outros acompanhantes). Aproximadamente metade dos pacientes tinham até 5 anos de idade, cerca de 2/3 apresentavam doenças de resolutividade cirúrgica simples e definitiva e 181 famílias (89,17%) contavam com renda familiar mensal de até R$ 1.999,00. A proporção de famílias beneficiadas por transporte gratuito variou entre 4,26-15,56% para pacientes morando até 100km de distância do hospital (45,83% para pacientes com residência a mais de 100km da instituição). Dos responsáveis, 176 (87,13%) relataram despesas ...
International braz j urol
Journal of Pediatric Urology, Feb 1, 2021
Journal of Pediatric Surgery, 2024
Introduction: Ileal obstruction caused by thick meconium associated with functional immaturity (I... more Introduction: Ileal obstruction caused by thick meconium associated with functional immaturity (IOMFI) is an uncommon disease associated with prematurity. IOMFI is not well known, and late or wrong diagnosis is a problem. In this research, we review the clinical characteristics and therapeutic methods of IOMFI.
Methods: Critical descriptive literature review.
Results: Most patients eliminate meconium previously to IOMFI. More premature babies tend to become symptomatic in their second week of life, with progressive abdominal distension. The most frequent complication is perforation. Radiologically there is diffuse intestinal distention without air-fluid levels. In contrast enema a caliber transition zone is observed in the distal ileum with multiple filling defects in the ileum and colon. Neural ganglia are present in biopsies from the rectum, colon, and stoma, mostly with characteristics of immature ganglia. Most patients respond to treatment with water soluble contrast enemas. Surgery is needed for patients who do not respond to enemas and those presenting perforations.
Discussion: IOMFI literature is limited to retrospective mainly small and heterogeneous cohorts. Patients usually respond promptly to water soluble enemas, but a favorable response is highly dependent in contrast reflux through the ileocecal valve and success is related to early treatment. Contrast inflow may be controlled by intermittent radiographies or real time ultrasound.
Revista CIPERJ, 2024
INTRODUCTION: Bilateral nodular adrenal hypertrophy (NBAH) is a rare genetically-determined disea... more INTRODUCTION: Bilateral nodular adrenal hypertrophy (NBAH) is a rare genetically-determined disease, presenting as ACTH-independent hypercortisolism. Three different presentations are known (macronodular, isolated micronodular, and pigmentary micronodular, all of which may show in isolated, familiar or syndromic forms. Treatment relies on bilateral adrenalectomy.
METHODS: Case report.
RESULTS: 10 years-old female with a one year history of Cushing syndrome. After investigation, ACTH-independent hypercortisolism, normal cranial image exams, and bilateral nodular adrenal hypertrophy were demonstrated. She was genetically tested, with the diagnosis of pigmentary nodular bilateral adrenal hyperplasia (PRKAR1A stop codon variant). The patient was submitted to a bilateral laparoscopic adrenalectomy, and being treated with corticosteroids and mineralocorticoids (physiologic doses), without complications. The patient has been followed up for 1 year. Her symptoms regressed, except for short height.
DISCUSSION: NBAH, described in 1964, causes < 2% of the cases of hypercortisolism. Image exams show bilateral augmented and diffusely nodular adrenal glands. In children familiar and syndromic forms are frequent. Micronodular pigmentary NBAH shows scattered hypodense micronodules on CT, without significant augmented dimensions of the adrenal glands and typically affects young adults. Treatment demands bilateral adrenalectomy, but extensive research to find effective pharmachological treatments is in course.
Revista CIPERJ, 2024
INTRODUÇÃO: cirurgias para de ampliação vesical são frequentemente indicadas em portadores de bex... more INTRODUÇÃO: cirurgias para de ampliação vesical são frequentemente indicadas em portadores de bexiga neuropática. Cateterismo vesical intermitente limpo trans-uretral pode ser difícil para pacientes femininas, em especial se cadeirantes. A construção de um conduto cateterizável continente facilita o cateterismo e aumenta a chance de independência do paciente para o auto-cuidado. Muitos pacientes apresentam também constipação crônica refratária, que pode ser tratada com lavagens colônicas anterógradas nos casos mais graves. A construção de condutos cecais cateterizáveis ou cecostomias com button facilitam o procedimento. Em alguns casos constipação crônica grave porolongada induz megasigmóide secundário, com piora progressiva da constipação e risco de volvo de sigmoide. Neste artigo discutimos o processo de escolha e execução de uma ampliação vesical em uma paciente apresentando variações anatômicas que obrigaram a equipe cirúrgica ao uso de alternativas técnicas pouco usuais.
MATERIAL E MÉTODOS: relato de caso
RESULTADOS: Paciente feminina, 9 anos, hidrocefalia valvulada, spina bífida lombar, obesidade e malformação grave das duas mãos e antebraços, cadeirante, indicação de ampliação vesical e construção de conduto urinário cateterizável continente. O inventário de cavidade revelou (1) mesentério do intestino delgado curto; (2) apêndice rudimentar; (3) megasigmóide de grandes dimensões. A equipe cirúrgica optou por (1) Ampliação vesical com sigmoide; (2) Construção de um conduto cateterizável a partir de retalho vascularizado baseado na borda mesentérica do sigmoide e (3) Apendicectomia e construção de cecostomia com cateter. A paciente evoluiu sem complicações. Passou a apresentar evacuações diárias espontâneas. Após 5 meses encontra-se continente, CIL sem dificuldades através do conduto cateterizável.
DISCUSSÃO: Através de variações e múltiplos conceitos embasados em literatura, foi escolhido um tratamento customizado para esta paciente e suas características fisiopatológicas incomuns. Há um papel de causalidade do megasigmóide na manutenção de quadros de constipação grave, que pode ser tratada com sigmoidectomia. A necessidade de preparo de cólon para a realização de cirurgias que envolvem anastomoses colônicas tem sido questionada. Várias metanálises têm sugerido que o preparo formal de cólon deve ser evitado.
Journal of Pediatric Surgery Open
Journal of Pediatric Urology, Aug 1, 2022
Journal of Pediatric Urology, Oct 1, 2012
A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with ... more A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with high inflammatory markers (C reactive protein and erythrocyte sedimentation rate). Biopsies of the testes and epididymides showed bilateral epididymal and testicular granulomata, testicular fibrosis and chronic inflammatory infiltration, and the histological diagnosis was granulomatous orchitis. The symptoms receded with oral corticosteroids. Although rare, granulomatous orchitis is a possible diagnosis in children presenting testicular enlargement. It is important to differentiate it from testicular tumors (if necessary with testicular biopsy) and to investigate its association with systemic vasculitis and infectious diseases.
Revista Paulista de Pediatria, Sep 1, 2015
Objective: To describe an adolescent with pathologic aerophagia, a rare condition caused by exces... more Objective: To describe an adolescent with pathologic aerophagia, a rare condition caused by excessive and inappropriate swallowing of air and to review its treatment and differential diagnoses. Case description: An 11-year-old mentally impaired blind girl presenting serious behavior problems and severe developmental delay with abdominal distension from the last 8 months. Her past history included a Nissen fundoplication. Abdominal CT and abdominal radiographs showed diffuse gas distension of the small bowel and colon. Hirschsprung's disease was excluded. The distention was minimal at the moment the child awoke and maximal at evening, and persisted after control of constipation. Audible repetitive and frequent movements of air swallowing were observed. The diagnosis of pathologic aerophagia associated to obsessive-compulsive disorder and developmental delay was made, but pharmacological treatment was unsuccessful. The patient was submitted to an endoscopic gastrostomy, permanently opened and elevated relative to the stomach. The distention was resolved, while maintaining oral nutrition. Comments: Pathologic aerophagia is a rare self-limiting condition in normal children exposed to high levels of stress and may be a persisting problem in children with psychiatric or neurologic disease. In this last group, the disease may cause serious complications. Pharmacological and behavioral treatments are ill-defined. Severe cases may demand surgical strategies, mainly decompressive gastrostomy.
World Journal of Urology, Dec 9, 2012
Objective Abnormal uroflowmetries are common after tubularized incised plate urethroplasties (TIP... more Objective Abnormal uroflowmetries are common after tubularized incised plate urethroplasties (TIP), perhaps due to low compliance. We hypothesized that (1) abnormal uroflowmetries after TIP might be caused by segmental lower compliance; (2) by adding a graft to the raw area in the incised plate (TIPG), compliance might be improved by preventing secondary intention healing of the dorsal incision. Methods A standardized penectomy was performed in 27 adult male rabbits: 9 normal non-operated controls (G1), 6 weeks after TIP (G2: n = 9) or TIPG (G3: n = 9).
PubMed, Dec 1, 2009
This paper proposes to discuss the training methodologies for young surgeons, considering the mod... more This paper proposes to discuss the training methodologies for young surgeons, considering the modern needs, by discussing their expectations and the reality of the surgeons' job market nowadays. Scientific and technological novelties, the huge amount of information imposed daily, managerial interventions and cost issues modified radically the activities of the surgeons, especially if compared to classical conceptions. Recent re-readings of the classical ethical postulates demand a new behavior of the doctors concerning the patients and the society per se. Contemporaneous social culture bring about individual expectations concerning quality of life and professional perspective issues. It becomes necessary to modify the training methods for surgeons to make them adequate to the need of continuous learning and adaptation to new technological instruments. They also should adapt to social interactions with the patients and the other health professionals that fit nowadays expectations. Those structural adaptations are fundamental to maintain the interest of the new professionals in the area of surgery.
Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysrap... more Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysraphism. Description: We treated a 2 month-old boy presenting with an extensive lumbosacral deformity, hydrocephalus and apparent enteric segments in the dorsal midline, accompanied by an enteric fistula and imperforated anus. The malformation was diagnosed as split notochord syndrome. The baby died as a result of sepsis before surgical treatment could be attempted. Comments: Split notochord syndrome is the rarest form of neuroenteric cyst described until this moment (<25 cases in the literature). It is frequently associated with anorectal malformation, intestinal fistulae and hydrocephalus. Prognosis is not necessarily poor and survival is possible if digestive malformations, hydrocephalus and the dysraphism itself are treated simultaneously.
Revista do Colégio Brasileiro de Cirurgiões, Apr 1, 2012
Objetivo: Verificar o estado da arte no tratamento dos refluxos vesicoureterais (RVU) persistente... more Objetivo: Verificar o estado da arte no tratamento dos refluxos vesicoureterais (RVU) persistentes alem da infância. Metodos: Revisao de literatura. Resultados: Foram revisados os dados de literatura com relacao ao tratamento e as complicacoes do refluxo vesicoureteral persistente no adolescente e no adulto. Conclusao: Nao ha dados que permitam aconselhar o tratamento intervencionista (cirurgico ou endoscopico) do refluxo vesicoureteral no adolescente e adulto, exceto em pacientes com lombalgia secundaria a doenca e infeccao urinaria (ITU) febril recorrente mesmo com tratamento clinico correto. A cirurgia aumenta o risco de complicacoes obstetricas urologicas obstrutivas sem modificar outras variaveis obstetricas, que sao primariamente determinadas pela presenca de cicatrizes renais e pela maior susceptibilidade a infeccoes urinarias, independente da presenca de RVU em atividade. Nao ha dados disponiveis para analisar as consequencias clinicas tardias do tratamento endoscopico do RV...
Springer eBooks, Dec 1, 2021
Jornal de Pediatria, 2004
Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysrap... more Objective: We present a case of split notochord syndrome, an extremely rare form of spinal dysraphism. Description: We treated a 2 month-old boy presenting with an extensive lumbosacral deformity, hydrocephalus and apparent enteric segments in the dorsal midline, accompanied by an enteric fistula and imperforated anus. The malformation was diagnosed as split notochord syndrome. The baby died as a result of sepsis before surgical treatment could be attempted. Comments: Split notochord syndrome is the rarest form of neuroenteric cyst described until this moment (< 25 cases in the literature). It is frequently associated with anorectal malformation, intestinal fistulae and hydrocephalus. Prognosis is not necessarily poor and survival is possible if digestive malformations, hydrocephalus and the dysraphism itself are treated simultaneously.
Cadernos de Saúde Pública
Nesta pesquisa, estudamos os custos de transporte por consulta ambulatorial em pacientes referenc... more Nesta pesquisa, estudamos os custos de transporte por consulta ambulatorial em pacientes referenciados para avaliação cirúrgica especializada em um hospital terciário no Rio de Janeiro, Brasil. Trata-se de um estudo descritivo com responsáveis por pacientes pediátricos agendados para consulta de cirurgia pediátrica, questionando fatores ligados ao custo de transporte e de oportunidade (perda de remuneração, alimentação, pagamento de cuidadores para outros filhos, despesas para outros acompanhantes). Aproximadamente metade dos pacientes tinham até 5 anos de idade, cerca de 2/3 apresentavam doenças de resolutividade cirúrgica simples e definitiva e 181 famílias (89,17%) contavam com renda familiar mensal de até R$ 1.999,00. A proporção de famílias beneficiadas por transporte gratuito variou entre 4,26-15,56% para pacientes morando até 100km de distância do hospital (45,83% para pacientes com residência a mais de 100km da instituição). Dos responsáveis, 176 (87,13%) relataram despesas ...
International braz j urol
Journal of Pediatric Urology, Feb 1, 2021
Recém-nascido prematuro de 33 semanas e 1260g, do sexo masculino, foi diagnosticado com AE e FTE,... more Recém-nascido prematuro de 33 semanas e 1260g, do sexo masculino, foi
diagnosticado com AE e FTE, mielomeningocele com hidrocefalia e provável
síndrome de Edwards. Com 2 dias de vida, foi submetido à correção da
mielomeningocele e derivação ventrículo-peritoneal (DVP). A correção da AE estava
prevista para o quinto dia, porém apresentou instabilidade hemodinâmica durante a
indução anestésica e a abordagem torácica. Foi realizada uma laparotomia
exploradora que revelou laceração gástrica extensa de cerca de 6 cm. Foram
realizados procedimentos de rafia gástrica, fechamento do esôfago distal,
gastrostomia e drenagem torácica direita.
Paciente do sexo feminino, com 3 anos e 9 meses, apresentava desde lactente uma massa palpável no... more Paciente do sexo feminino, com 3 anos e 9 meses, apresentava desde lactente uma massa
palpável no hipocôndrio esquerdo, estendendo-se até o flanco esquerdo. Realizou
ultrassonografia que evidenciou uma volumosa formação cística expansiva, representando um
saco hidronefrótico. A DMSA mostrou exclusão funcional do rim esquerdo e rim direito
funcionalmente normal ao DTPA. No intraoperatório, foi identificada dilatação cística volumosa
com ureter em fundo cego no polo superior do rim esquerdo, e o polo inferior aparentemente
fundido à direita com a presença de hilo renal e ureter pérvio. Foi realizada nefrectomia polar
superior esquerda. A ultrassonografia pós-operatória evidenciou rim direito tópico, rim
esquerdo com dimensões reduzidas, fusionado ao polo inferior do rim direito (ectopia renal
cruzada), e ureteres sem alterações. A paciente evoluiu satisfatoriamente no pós-operatório,
sem intercorrências.
Meconium obstruction and functional immaturity in neonates, 2024
A obstrução causada por mecônio espesso associado à imaturidade funcional (IOMFI) é rara (1-2 pac... more A obstrução causada por mecônio espesso associado à imaturidade funcional (IOMFI) é rara (1-2 pacientes: 1.000.000 neonatos vivos), pouco conhecida e típica de prematuros de extremo baixo peso. Sua prevalência está aumentando devido à maior sobrevida desses neonatos.
XXXVII Congresso brasileiro de cirurgia pediátrica, 2024
Neonato feminino prematuro (33 semanas de idade gestacional), com mãe cardiopata, submetida a val... more Neonato feminino prematuro (33 semanas de idade gestacional), com mãe cardiopata,
submetida a valvuloplastia no primeiro trimestre de gestação. Um ultrassom no segundo
trimestre de gestação mostrou polidrâmnio e dilatação de alças ileais fetais. O neonato não
eliminou mecônio e apresentava distensão gástrica e duodenal em uma avaliação radiológica.
Foi realizada uma laparotomia no 5º dia de vida. Identificou-se duodeno dilatado até a 3º
porção e 11 segmentos isolados ou estenosados em jejuno e íleo, sem defeitos no
mesentério. Foram ressecados os segmentos intestinais com menos de 3 cm de perviedade e
anastomosados os demais segmentos de forma término-terminal. O comprimento final do
intestino delgado reconstruído foi de 60 cm. A paciente evoluiu com íleo prolongado e vômitos
de repetição, até aceitação plena de dieta enteral após 45 dias de vida, com crescimento
adequado.