Browsing by Author "Miranda, A"
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- Diabetes Gestacional: Avaliação dos Desfechos Maternos, Fetais e NeonataisPublication . Miranda, A; Fernandes, V; Marques, M; Castro, L; Fernandes, O; Pereira, MLIntrodução: Apesar dos progressos na vigilância e tratamento da diabetes gestacional (DG), os resultados obstétricos e neonatais ainda não igualaram os da gravidez sem esta complicação. Este estudo pretendeu caracterizar uma população de grávidas com DG comparando-a com uma população obstétrica com rastreio de DG negativo. Material e Métodos: Realizámos um estudo observacional e retrospetivo, através da consulta de processos clínicos de 201 grávidas com DG e 201 grávidas com rastreio de DG negativo, com seguimento e parto no nosso hospital. Resultados: As grávidas com DG apresentaram idade mais avançada (33 vs 31 anos, p = 0,001) e maior prevalência de hipertensão gestacional (6% vs 2%, p = 0,041). O grupo da DG registou uma taxa de cesariana mais elevada (40,3% vs 24,4%, p = 0,001), sendo a incompatibilidade céfalo-pélvica o principal motivo de cesariana (32,9%). Não se verificaram diferenças entre os grupos relativamente ao peso fetal ao nascimento. Recém-nascidos de mães com DG tiveram mais distócia de ombros (3% vs 0%, p = 0,014) e foram mais frequentemente admitidos da Unidade de Cuidados Intensivos Neonatais (14,9% vs 8,5%, p = 0,044), principalmente por hipoglicemia. Não foram encontrados fatores de risco para este desfecho. Discussão: Grávidas com DG eram mais velhas, apresentaram maior incidência de hipertensão gestacional, parto por cesariana e morbilidade neonatal relativamente ao grupo controlo. Conclusão: No presente estudo, a ocorrência de DG condicionou um aumento da morbilidade obstétrica e, sobretudo, neonatal.
- Hybrid endoscopic thymectomy : combined transesophageal and transthoracic approach in a survival porcine model with cadaver assessmentPublication . Moreira-Pinto, J; Ferreira, A; Miranda, A; Rolanda, C; Correia-Pinto, JBACKGROUND: Video-assisted thoracoscopic surgery thymectomy has been used in the treatment of Myastenia Gravis and thymomas (coexisting or not). In natural orifice transluminal endoscopic surgery, new approaches to the thorax are emerging as alternatives to the classic transthoracic endoscopic surgery. The aim of this study was to assess the feasibility and reliability of hybrid endoscopic thymectomy (HET) using a combined transthoracic and transesophageal approach. METHODS: Twelve consecutive in vivo experiments were undertaken in the porcine model (4 acute and 8 survival). The same procedure was assessed in a human cadaver afterward. For HET, an 11-mm trocar was inserted in the 2nd intercostal space in the left anterior axillary line. A 0° 10-mm thoracoscope with a 5-mm working channel was introduced. Transesophageal access was created through a submucosal tunnel using a flexible gastroscope with a single working channel introduced through the mouth. Using both flexible (gastroscope) and rigid (thoracoscope) instruments, the mediastinum was opened; the thymus was dissected, and the vessels were ligated using electrocautery alone. RESULTS: Submucosal tunnel creation and esophagotomy were performed safely without incidents in all animals. Complete thymectomy was achieved in all experiments. All animals in the survival group lived for 14 days. Thoracoscopic and postmortem examination revealed pleural adhesions on site of the surgical procedure with no signs of infection. Histological analysis of the proximal third of the esophagus revealed complete cicatrization of both mucosal defect and myotomy site. In the human cadaver, we were able to replicate all the procedure even though we were not able to identify the thymus. CONCLUSIONS: Hybrid endoscopic thymectomy is feasible and reliable. HET could be regarded as a possible alternative to classic thoracoscopic approach for patients requiring thymectomy.
- Left atrial appendage ligation with single transthoracic port assistance: a study of survival assessment in a porcine modelPublication . Moreira-Pinto, J; Ferreira, A; Miranda, A; Rolanda, C; Correia-Pinto, JBACKGROUND: Left atrial appendage (LAA) exclusion is a well-known procedure for the prevention of stroke in high-risk patients with atrial fibrillation and contraindication to long-term oral anticoagulant therapy. OBJECTIVE: To evaluate a natural orifice transluminal endoscopic surgery (NOTES) approach for LAA ligation. DESIGN: In 4 acute and 6 survival pigs, we performed LAA by using a forward-viewing, single-channel gastroscope and an operative thoracoscope with a 3-mm working channel (introduced through an 8-mm single transthoracic port). SETTING: Animal laboratory. INTERVENTIONS: The gastroscope was introduced in the thoracic cavity through an esophageal submucosal tunnel. An end loop introduced through the gastroscope was used to legate the LAA. In the survival experiments, the esophageal mucosa was closed using hemoclips. MAIN OUTCOME MEASUREMENTS: The time, safety, and feasibility of the procedure were recorded. In the survival experiments, endoscopy and postmortem examination were performed on postoperative day 14. RESULTS: Creation of a submucosal tunnel and esophagotomy were safely performed in all animals without incidents. The mean time for esophagotomy was 17.0 ± 6.3 minutes. Pericardial dissection and LAA ligation were performed in all animals but 1. The mean time for LAA ligation was 34.4 ± 19.1 minutes. No adverse events occurred during the survival period. Endoscopy showed complete esophageal closure. Postmortem examination revealed pleural adhesions on the site of pericardial dissection, and the LAA was fibrotic with the endoloop in place. LIMITATIONS: Animal study. CONCLUSIONS: LAA ligation with single transthoracic trocar assistance is feasible and may be an alternative to anticoagulant therapy or to permanent intracardiac implants in patients with atrial fibrillation.
- Transesophageal pulmonary lobectomy with single transthoracic port assistance: study with survival assessment in a porcine modelPublication . Moreira-Pinto, J; Ferreira, A; Miranda, A; Rolanda, C; Correia-Pinto, JBACKGROUND AND STUDY AIMS: Thoracoscopic pulmonary lobectomy is being performed in an increasing number of patients. The aims of the current study were to assess natural orifice transluminal endoscopic surgery (NOTES) as an alternative to transthoracic endoscopic surgery, and to test the feasibility of peroral transesophageal right upper pulmonary lobectomy with the assistance of a single transthoracic trocar. METHODS: In 10 acute and 4 survival pigs, right upper pulmonary lobectomy was performed using a forward-viewing double-channel gastroscope and an operative thoracoscope with a 5-mm working channel inserted through a single transthoracic 12-mm) port. Time, safety, and feasibility of the following steps were recorded in all animals: esophagotomy, hilar dissection, individual ligation of the hilum elements, pulmonary lobectomy, and specimen retrieval. In the survival experiments, esophagotomy was closed using a reticulated laparoscopy suture device and an esophageal stent was placed. These animals were kept alive and monitored for 2 weeks. RESULTS: Esophagotomy was performed safely in all animals (mean procedure duration 5.4 ± 1.7 minutes). Dissection of the right upper lobe hilum elements (bronchus, arteries, and veins) was carried out without adverse events. Individual ligation of the hilum elements was performed in all but two cases (time for dissection and ligation 44.2 ± 14.8 minutes). Lobectomy and specimen retrieval were completed in all animals (9.5 ± 3.1 minutes). Esophagotomy closure and stent placement were carried out in 20.0 ± 2.8 minutes in the survival animals. These animals fed normally and gained weight postoperatively without signs of disease. Endoscopic examination before necropsy revealed a pseudo-diverticulum in one animal, and wound dehiscence with confined collection/recess in the remaining animals. CONCLUSIONS: Transesophageal right upper pulmonary lobectomy using single transthoracic trocar assistance is feasible and may represent a step towards scar-free pulmonary lobectomy.