Navegando por Autor "Zocratto, Orlando Barreto"
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Item Cirurgia de separação laringotraqueal : resultados em 43 pacientes com aspiração pulmonar crônica e persistente.(2017) Zocratto, Orlando Barreto; Zocratto, Keli Bahia FelicíssimoObjetivo: Avaliar os resultados em 43 pacientes com aspiração pulmonar clinicamente intratável submetidos à cirurgia de separação laringotraqueal (SLT). Desenho do estudo: Estudo retrospectivo. Método: Análise retrospectiva de 43 pacientes submetidos à SLT com objetivo de tratar a aspiração pulmonar crônica e persistente. Foram avaliadas as seguintes variáveis: taxa de eficácia, morbidade, mortalidade e taxa de reversibilidade da SLT. Resultados: Três (7,0%) pacientes morreram durante o pós-operatório imediato. Estes pacientes foram excluídos da avaliação da eficácia do procedimento, mas incluídos na avaliação de morbidade e mortalidade. SLT foi eficaz no controlo da aspiração pulmonar em 36 (90,0%) pacientes e foi ineficaz em quatro (10,0%) dos 40 pacientes. Dezesseis (44,4%) dos 36 pacientes cuja operação eficaz foram capazes de ingerir por oral exclusiva. Vinte e três (53,5%) pacientes desenvolveram complicações pós-operatórias. A fístula traqueocutânea foi a complicação mais frequente e foi observada em 14 (32,6%) pacientes. Entre estes, dez (71,4%) tinham traqueostomia previa e quatro (28,6%) não haviam sido submetidos à traqueostomia antes SLT (p = 0,008; RR = 3,82; IC = 1,43-10,24). Cinco (11,6%) pacientes desenvolveram estenose traqueostomal. Reversão da SLT foi possível em dois (4,7%) pacientes. Conclusão: SLT é eficaz no tratamento da aspiração pulmonar clinicamente intratável. A incidência de complicações pós-operatórias é significativa. A fístula traqueocutânea no coto traqueal proximal é a complicação mais frequente, especialmente em pacientes com traqueostomia prévia. Mortalidade depende da condição do paciente. O procedimento é potencialmente reversível. Apesar de todos esses fatos, a possibilidade de reversão não parece ser uma vantagem em pacientes com aspiração pulmonar clinicamente intratável.Item Effects of clonidine, isoflurane, and the clonidine+isoflurane association in isolated hearts.(2023) Dupin, João Bosco; Alberti, Luiz Ronaldo; Zocratto, Orlando BarretoBackground: 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.Item Há indicação para a realização da cirurgia de separação laringotraqueal para a prevenção de aspiração pulmonar em pacientes com tumores de cabeça e pescoço?(2013) Zocratto, Orlando Barreto; Lima, Daniel Xavier; Souza, Iure Kalinine Ferraz de; Lopes, Lauro Nogueira; Toledo, Vinicius NogueiraAvaliar os resultados obtidos em pacientes com câncer de cabeça e pescoço submetidos à extensas ressecções das vias aéreas e digestivas superiores associada à cirurgia de separação laringotraqueal (SLT). Esta tinha o objetivo de prevenir potencial aspiração pós-operatória. Desenho do Estudo: Análise retrospectiva. Estabelecimentos: Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG) e o Hospital Biocor. Método: Análise dos prontuários médicos de 30 pacientes com câncer de cabeça e pescoço, cuja exérese tem, sabidamente, grande potencial de causar aspiração pulmonar no pós-operatória. Eles foram submetidos à que se submeteram à realização da SLT juntamente com a ressecção do tumor, no período de 1991 a 2008. As seguintes variáveis foram avaliadas: prevenção de potencial e grave aspiração pulmonar pós-operatória, morbidade e taxa de reversibilidade da LTS. Resultados: A cirurgia foi eficaz em 100,0% dos casos. Seis (20,0%) pacientes tiveram complicações pós-operatórias, ou seja, edema, estenose de traqueostomia e fístula traqueocutânea do coto proximal da traqueia. A cirurgia para reversão LTS foi realizada em 11 (36,7%) pacientes, sendo eficaz em nove (81,8%); cinco (45,5%) tiveram complicações pós-operatórias. Conclusões: A SLT impediu a ocorrência de aspiração pulmonar pós-operatória em pacientes submetidos à extensas ressecções das vias aéreas e digestivas superiores. O procedimento é potencialmente reversível e tem uma alta taxa de eficácia. No entanto, a frequência de complicações para ambas LTS e, especialmente sua reversão, não pode ser negligenciada. Descritores: separação laringotraqueal, prevenção de aspiração pulmonar, câncer de cabeça e pescoço, deglutição, desordens de deglutição.Item Long-term outcomes of reversal of laryngotracheal separation.(2009) Zocratto, Orlando Barreto; Rocha, Paulo Roberto Savassi; Paixão, Rafael de MattosThe aim of this study was to evaluate the longterm outcomes of the reversal of laryngotracheal separation (LTS) in patients who underwent extensive resection of tumors located in the upper aerodigestive tract. We performed a retrospective analysis of the medical records of eight patients who had LTS reversal. The operation was successful in six patients who were followed up for a period of 17-99 months (mean = 46.3 ± 26.2). The mean interval between LTS and surgical reversal was 16.6 ± 9.1 months. Four patients had postoperative complications: mild to moderate transient aspiration in two, tracheal stenosis in one, and severe aspiration followed by tracheal stenosis in one. In the last two cases, surgical reversal was not successful. The patients whose surgery was effective maintained oral feeding and comprehensible speech until the end of the follow-up period. We conclude that reversal of LTS is technically simple and, when successful, permits the return to oral feeding and comprehensible speech for an indefinite period of time. However, the frequency of complications and inefficacy of LTS reversal should not be overlooked.Item Quality of life evaluation of patients with neurogenic bladder submitted to reconstructive urological surgeries preserving the bladder.(2015) Lima, Daniel Xavier; Pires, Cleidismar Rosa; Santos, Ana Clara Rezende dos; Mendes, Raphaela Gomes; Fonseca, Carlos Eduardo Corradi; Zocratto, Orlando BarretoTreatment of neurogenic bladder (BN) aims to upper urinary tract protection. When the conservative clinical measures are insufficient, surgical treatment is indicated. Though admittedly important, the quality of life (QoL) has been little studied in these patients, there are even contradictory results. The aim of this study was to evaluate QoL before and after bladder augmentation in patients with BN refractory to medical treatment. We analyzed, prospectively, the data of 67 patients who underwent surgical treatment for BN by questionnaire SF-36® and Qualiveen® QoL before and after six months of operation. Comparisons using paired t-tests and Wilcoxon and the assumption of normality was assessed using the Shapiro-Wilk test were made. According to the analysis of the SF-36® questionnaire, the patients had higher QoL indices in the postoperative period in the areas functional capacity, general state of health, vitality, social aspects, emotional aspects and mental health (n = 67; p <0.05). The questionnaire also revealed Qualiveen® best result in quality of life index in the postoperative period, and show lower specific negative impact by urinary problems (n = 36; p <0.05). The results show that, despite not being the main objective, the bladder augmentation results in significant improvement in QoL, probably related to the perception of better health and the resolution of urinary incontinence. Thus, the bladder augmentation associated with other urologic reconstruction techniques allows the upper urinary tract protection, and contribute to a better quality of life of patients with BN.Item Schwannoma in cervicothoracic topography : an unusual case report.(2020) 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 AraújoO 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.Item The Amatsu’s tracheoesophageal shunt : analysis of 84 cases.(2014) Zocratto, Orlando Barreto; Vieira, Mauro Becker Martins; Maia, Amelio Ferreira; Ferreira, Ariane Cardoso; Larangeira, Laura Tassis; Penido, Mariana Nassur Rancanti; Silva, Lucas Leandro AraújoSummary: Introduction. Amatsu’s tracheoesophageal shunt can be indicated for vocal rehabilitation in candidates to total laryngectomy. It is performed in the period of the procedure of total laryngectomy and has been indicated due to its technical facility, exemption from the use of voice prosthesis, and lack of additional costs for its maintenance. Objective. To evaluate the results obtained with the Amatsu’s tracheoesophageal shunt, along 14 years of experience, in two Brazilian hospitals. Study Design. Clinical retrospective. Material and Method. From 1991 to 2005, eighty-four patients were submitted to the Amatsu’s tracheoesophageal shunt. Seventy-seven (91.7%) were male and seven (8.3%) female, aged between 30 and 82 years, mean age of 57.5 years, and an average age of 52 years. All patients had squamous cell carcinoma of larynx and/or hypopharynx. Sixty-eight (81.0%) were stage III or IV. They were submitted to total laryngectomy and the Amatsu’s tracheoesophageal shunt was performed during the tumor removal surgery. The following variables were analyzed: acquisition of intelligible speech, vocal recovery time after surgery, and the occurrence of specific surgical complications of the shunt (pulmonary aspiration). Results. Seventy-six patients were evaluated with respect to the effectiveness of the technique. Fifty-three patients (70.0%) presented vocalization by the shunt; in 46 patients (60.5%), the speech was fully intelligible. The time required for restoration of speech was 12–87 postoperative days. Of the 83 patients evaluated in relation to the development of complications, 25 (30.1%) presented aspiration by the shunt during oral ingestion. In 23 patients (27.7%), the aspiration was managed conservatively without complications. Two patients (2.4%) required surgical closure of the shunt due to intractable aspiration. Conclusion. Vocal rehabilitation with the Amatsu’s tracheoesophageal shunt is effective in most patients who underwent total laryngectomy. It can be evidenced by the acquisition of intelligible speech in most patients. The aspiration, although often, is not shown to be a limiting complication.Item The role of alpha-adrenergic agonists in the myocardial ischemia prevention.(2023) Dupin, João Bosco; Dupin, João Henrique; Zocratto, Orlando BarretoThe 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).Item Tracheocutaneous fistula as a complication of laryngotracheal separation surgery.(2012) Zocratto, Orlando Barreto; Zocratto, Keli Bahia Felicíssimo; Mao, Ana Yin Yin; Oliveira, Geovane Souza de; Tadeu, Luiza Ferreira RibeiroTo evaluate the relationship between the occurrence of tracheocutaneous fistula of the proximal tracheal stump regarding the indication (therapeutic or prophylactic) of laryngotracheal separation surgery (LTS) and regarding the presence of a current or previous tracheostomy when LTS was performed. Retrospective analysis of 66 patients submitted to LTS. The tracheocutaneous fistula occurred in 14 (21.2%) patients. Twelve (33.3%) of 36 patients whose indication was therapeutic and in two (6.7%) of 30 patients whose indication was prophylactic (p = 0.019). It occurred in 8 (57.1%) of 14 patients who had undergone tracheostomy prior to completion of LTS, while occurred in 6 (11.5%) patients who had not previously undergone tracheostomy (n = 52) (p = 0.0009). The incidence of tracheocutaneous fistula as a postoperative complication of laryngotracheal separation is high and occurs mainly in patients whose indication is therapeutic and for those with a current or previous tracheostomy.