Biomedical subjects

E M Utiyama

Publications and source records attributed to E M Utiyama.

18 recordsLinked to original sources

PubMed2001

Prosthetic repair of incisional hernia in kidney transplant patients. A technique with onlay polypropylene mesh.

The employment of synthetic mesh for incisional hernia repair in kidney-transplanted patients is rarely reported in the present literature. Many authors believe that mesh employment in such conditions is not safe due to fear of mesh related complications. From 1965 through 1999, a total of 1685 kidney transplants were performed at our Kidney Transplant Unit and 19 patients developed eventrations in the kidney transplant incision, an incidence of 1.1%. From September 1996 eight of these patients had prosthetic repair of the abdominal wall with onlay polypropylene mesh. All patients were under immunosuppressive therapy with prednisone, ciclosporine and azathioprine. Mean age was 48.8 years, mean body mass index was 22.5 and mean number of previous abdominal operations was 2.5. A large polypropylene mesh (Marlex mesh) was fixed over the aponeurosis after primary closure of the aponeurotic borders, as an onlay graft. There was neither morbidity nor mortality associated to the surgical procedure. No recurrences or long-term complications associated with mesh employment were verified after a follow-up ranging from one year to three years. We concluded that prosthetic repair of incisional hernia in transplanted patients can be performed routinely.

Female↗

PubMed2000

Elective colonic operation and prosthetic repair of incisional hernia: does contamination contraindicate abdominal wall prosthesis use?

BACKGROUND: Wound infection and sepsis leading to incisional hernia development are common after emergency colonic operations. Later on, while being operated on to correct an incisional hernia, most of these patients will need colonic resection or bowel continuity reestablishment. Simultaneous treatment of incisional hernias in patients with colostomy or colonic disease remains a difficult challenge, considering the reluctance of most surgeons to treat both conditions at the same time, especially when prosthetic repair is needed. STUDY DESIGN: The aim of this study was to analyze the short-term results of patients undergoing colonic resection or bowel continuity reestablishment and simultaneous incisional hernia repair with an onlay polypropylene mesh technique. Over a period of 6 years, 20 patients were operated on for colonic problems associated with incisional hernias, including 8 Hartmanns' colostomies, 6 colostomies or ileostomies with colonic mucous fistulas, 3 postoperative colocutaneous fistulas, a paracolostomic hernia, a Chagas' megacolon, and a pseudotumoral diverticulitis. A "rule of three" statistical analysis was used to estimate the maximum risk of adverse effects, concerning mesh-related morbidity, after 1- and 2-year followup. RESULTS: A major complication occurred in a patient who developed an anastomotic leakage and secondary wound infection; the patient was treated with parenteral nutrition and antibiotics. Other complications included a minor wound infection, a seroma, and a chronic sinus. One patient died from postoperative problems unrelated to the surgical technique. The occurrence of postoperative wound infection did not prevent mesh incorporation. Followup ranging from 1 to 7 years detected no hernia recurrences; 13 patients were followed for 2 years or more. Our results suggest that risk of mesh-related morbidity does not exceed 15.8% (3 of 19) within the first year and 23.1% (3 of 13) for 2 years followup, with 95% confidence. CONCLUSIONS: We concluded that prosthetic repair of incisional hernias associated with simultaneous colonic operations was possible, allowing abdominal wall anatomy reestablishment. There is no reason to believe that abdominal wall prostheses must be avoided in contaminated operations when an adequate surgical technique is used.

Abdominal Muscles↗

PubMed1990

Open pelviperineal trauma.

The authors present their results in the management of 48 patients with complex pelviperineal injuries treated at the Surgical Emergency Ward of the University of São Paulo School of Medicine General Hospital. The distinct factors influencing the morbidity and mortality rates are discussed as well as the importance of an aggressive treatment in the initial approach of these patients. The following steps are virtually essential for the achievement of results comparable to those presented in the present protocol: exhaustive irrigation of the perineal wound with saline solution followed by surgical debridement and removal of all devitalized areas, maintenance of the wound open, early maturation transverse colostomy with total fecal flow diversion, periodic surgical revisions at intervals of 24 to 72 hours, large doses of antibiotic therapy, nutritional support with full parenteral feeding, and appropriate management of bone injuries and skin grafts. Adopting of measures proposed in this protocol yielded a decrease in mortality rate from 70% to 31.5%.

Adolescent↗

PubMed1988

The efficacy of loop colostomy for complete fecal diversion.

In an attempt to evaluate the real efficacy of loop colostomy for fecal diversion, the authors studied 62 patients previously colostomized under emergency conditions. Radiologic series of the abdomen were taken after 200 gm of barium meal. The results showed that the colostomy provided complete diversion of the radiologic contrast in 53 patients (85 percent) and incomplete diversion in nine patients (15 percent). Analysis of the results revealed that incomplete fecal diversion was: 1) observed as of the 86th postoperative day, with a significantly higher frequency following the 10th postoperative month, and 2) significantly correlated with either colostomy retraction or prolapse. The authors present a diagram showing a possible interaction of factors responsible for incomplete fecal diversion in loop colostomy and conclude that: 1) retraction is probably the basic contributing factor for colostomy failure; 2) the prolapse, once reduced, propitiates sinking of the stoma, facilitating colostomy failure; 3) the common assumption that loop colostomy eventually fails to provide complete fecal diversion is further supported; 4) loop colostomy assures, over its usual duration, a satisfactory defunctionalization of the colon; and 5) use of improved techniques of colostomy construction may prolong complete fecal diversion.

Abdominal Muscles↗

PubMedDate not supplied

[Fournier syndrome: evaluation and initial treatment].

The records of 48 patients with Fournier's syndrome (FS) treated at the Emergency Surgical Service of the Hospital das Clínicas of the University of São Paulo Medical School in the period 1982-1991 were reviewed. Clinical and laboratory data at admission were analysed. The following factors were statistically significant when associated with bad prognosis: elevated serum creatinine, hypoxemia, metabolic alkalosis or acidosis, diabetes and age over 50 years. Based on these five criteria, the patients were divided into two groups: Group I, mild FS (32 cases) and Group II, severe FS (16 patients). This classification permits a better planning of therapy. In cases classified as severe, treatment should include wide débridement, with resection of all necrotic tissues, scheduled reoperations for further débridements, transverse colostomy, wide spectrum antibiotic therapy and total parenteral nutrition. In the mild cases, the patients may be treated with débridement and antibiotics only.

Adolescent↗

PubMedDate not supplied

[Traumatic wounds of the esophagus].

Thirty four (75.5%) individuals sustained gunshot wounds, nine (20%) stab wounds, while two (4.4%) suffered blunt trauma. Thirty four patients (75%) displayed severance of the cervical portion of the esophagus, seven (15.5%) of the thoracic segment and only four (8.8%) had injuries on the abdominal portion. The cervical esophagus was surgically approached through oblique left side cervicotomy with primary suture and drainage with Penrose drain. A postero-lateral right side thoracotomy was employed for lesions of the upper and intermediate portion of the thoracic esophagus. When the lower portion of the esophagus was injured, a left side thoracotomy was employed. When the injury involved less than half of the perimeter of the esophagus suturing with ample drainage was adopted. In more extensive injuries involving over half of the perimeter total esophagectomy was the treatment of choice. In abdominal esophageal injuries laparotomy, suture and drainage were performed. Complications occurred in 40% of all patients. Seven patients died though only one from direct consequences of the esophageal injury. The authors believe that an early surgical approach for traumatic esophageal injuries is the best procedure. Primary suture and drainage score the best results. Other measures (esophagectomy, esophagostomy, gastrostomy) should be adopted only when the injury is either extensive or mediastinal contamination is present.

Adolescent↗

PubMedDate not supplied

[Perforated duodenal diverticulum: a report of 2 cases].

Two cases of perforated duodenal diverticulum, treated at the surgical Emergency Service of the Hospital das Clínicas of the University of São Paulo Medical School are reported. Although duodenal diverticula are frequent their perforation in is a rare and dougerous complication. Diagnosis and surgical treatment are discussed. We believe that excision, primary suture with an omental patch and drainage are procedures of choice for the treatment of this complication.

Adult↗

PubMedDate not supplied

[Complex pelviperineal injuries: systematization of the treatment].

The authors review the cases of complex pelviperineal injuries admitted to the Emergency Service of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo during the period 1983-1988. The management of these patients followed a protocol that consisted of: exhaustive lavage of the injury with extensive debridement, leaving the wound widely unsutured, matured loop colostomy, lavage of the distal colon, scheduled revisions at 48 to 72 hour intervals, intensive antibiotic treatment and early total parenteral nutrition. Thirty one patients were treated following these procedures, with a decrease in mortality due to sepsis from 50% to 16.1%.

Adolescent↗

PubMedDate not supplied