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Biomedical subjects

M C Velhote

Publications and source records attributed to M C Velhote.

5 recordsLinked to original sources
PubMed1999

Early discharge after appendicectomy in children.

OBJECTIVE: To confirm that "day-care" appendicectomy is safe in children. DESIGN: Prospective study. SETTINGS: Paediatric hospitals, Brazil. SUBJECTS: 144 children who required removal of the appendix. INTERVENTIONS: Standard muscle splitting appendicectomy. MAIN OUTCOME MEASURES: Hospital stay, use of antibiotics, and complications. RESULTS: 124 patients (86%) were discharged within 24 hours of operation. In all patients the appendicitis was confirmed and grouped according to histopathological findings (72 inflamed, 26 gangrenous and 26 perforated). 86 patients (60%) were given metronidazole one hour before operation as prophylaxis against postoperative abscess formation. 78 (54%) were given no antibiotics in the postoperative period. 2 patients were readmitted for drainage of intraperitoneal abscesses and 10 had subcutaneous abscesses drained as outpatients during the early postoperative period. The overall infective complication rate was 8% (n = 12), which is comparable with large series of appendicectomy in children. CONCLUSIONS: "Day-care" appendicectomy is safe and feasible in children, as it avoids a long hospital stay and increased costs with no additional risk.

Adolescent↗
PubMed1991

The endoscopic and surgical management of portal hypertension in children: analysis of 123 cases.

Since 1973, 178 children with portal hypertension (PH) have been seen at Instituto da Criança of the University of São Paulo Medical School. Fifty-five of these children were excluded from this analysis for various reasons, including no treatment required, death before treatment, or incomplete data. From the remaining 123 children with esophageal varices, only 96 (76.1%) of them had at least one episode of upper gastrointestinal hemorrhage. Eighty-eight children were submitted to injection sclerotherapy; 26 treated prophylactically, and 62 for treatment of previous bleeding. Eleven (42.3%) children from the prophylactic group bled from esophageal varices during the treatment. They were all successfully managed thereafter. Satisfactory results were achieved in 53 (85.4%) children in the therapeutic group. Twenty-eight (45.1%) children had at least one episode of bleeding after beginning of sclerotherapy, 19 of whom eventually had successful control of the variceal bleeding. From 1973 to 1984, distal splenorenal shunt (DSS) was the procedure of choice for the treatment of bleeding esophageal varices. Forty-two children have undergone DSS during this period. Only one child was shunted prophylactically. Since 1985, injection sclerotherapy has been the first choice for the treatment and only seven children with sclerotherapy failure have since been treated by DSS. Characteristically these children had very similar splenoportographic pattern with huge esophageal and gastric varices and deviation of portal vein blood flow toward the left gastric vein.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Videolaparoscopic appendectomy with linear stapler].

It is presented the experience of 126 cases of acute appendicitis treated by a videolaparoscopic appendectomy using a 12 mm endostapler with 4 lines of staples and a linear cutting device in the middle. It has been used two trocars (5 mm) at the left side and one other (12 mm) trocar at the umbilicus. In the first cases other dispositions were used but this one seemed to be better. Through the left trocars, a dissection is promoted, isolating the appendix, its base and its mesentery, in which a small hole is made, close to the base. Through this hole, it is passed one of the sides of the 12 mm stapler. The device promotes the bilateral stapling and cuts the appendix at its base. The stapler is reloaded with vascular staples and then the mesentery is stapled and cut by the same way. It is a very fast method. Besides, the laparoscopic option gives the opportunity to equally treat appendicitis at unusual positions, to examine other pelvic organs (eventually treating diseases) and to aspirate secretions under direct view, anywhere in the cavity. The specimen is taken out of the cavity inside a plastic bag and we had no case of infection at the trocar sites. Only in 3 cases there were conversion to open surgery, due to difficult dissection and identification of structures, in all of them with very advanced disease and necrosis. It is concluded that this method is fast, safe, easy (although more expensive) and can be utilized routinely, at least in the first approach of the treatment of acute appendicitis.

Adult↗