Publications by authors named "José Guilherme Minossi"

11 Publications

  • Page 1 of 1

Alloxan diabetes alters the tensile strength, morphological and morphometric parameters of abdominal wall healing in rats.

Acta Cir Bras 2014 Feb;29(2):118-24

UNESP, Faculty of Medicine, Department of Surgery and Orthopedics, BotucatuSP, Brazil, PhD, Full Professor, Department of Surgery and Orthopedics, Faculty of Medicine, UNESP, Botucatu-SP, Brazil. Critical revision.

Purpose: To investigate the effects of alloxan diabetes on the abdominal wall healing of rats undergoing laparotomy.

Methods: Ninety-six male Wistar rats weighing between 200 and 300 grams, divided into two groups: non-diabetic group (G1) and another with untreated diabetes (G2). Three months after diabetes induction, the animals underwent a 5cm-long- laparotomy and 5.0 nylon monofilament suture. After the surgery, 12 animals from each group were euthanized on days 4, 14, 21 and 30 corresponding to the moments M1, M2, M3 and M4. In each moment a fragment of the abdominal wall containing the scar was removed for tensile strength measurement, histological and morphometric study. Clinical and biochemical parameters were also analyzed.

Results: G2 animals showed parameters compatible with severe diabetes and decreased plasma levels of insulin. The tensile strength in G2 was significantly smaller in M2 and M4, with a tendency to fall in the other two. Through light microscope, diabetic animals showed more difficulty to increase collagen density and contraction. G2 animals showed high cellularity of fibroblasts in later healing moments, with collagen thinning in M2 and M4.

Conclusion: The abdominal wound healing in untreated diabetic animals was altered and led to a higher incidence of dehiscence and infections.
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http://dx.doi.org/10.1590/S0102-86502014000200008DOI Listing
February 2014

Alterations of the gastric stump and not resected stomach mucosa after truncal vagotomy in rats.

Acta Cir Bras 2014 Feb;29(2):99-103

Fellow Master degree, Postgraduate Program in General Basis of Surgery, Faculty of Medicine, UNESP, Botucatu-SP, Brazil.

Purpose: To evaluate morphological changes of the gastric stump and not resected stomach mucosa after the completion of truncal vagotomy.

Methods: Eighty male Wistar rats were divided into four groups: CT, TV, RY and RYTV. In CT group, abdominal viscera were manipulated and the abdominal cavity was closed, in TV vagal trunks were isolated and sectioned, in RY a partial Roux-en-Y gastrectomy was performed and in RYTV the vagal trunks were sectioned and a partial Roux-en-Y gastrectomy was performed. At the 54th week after surgery, the rats were euthanized. The findings were submitted to histological analyses.

Results: None macroscopic or histological alterations in groups TV and CT was observed. Specimens from RY and RYTV groups did not show alterations in the gastric stump mucosa. At the jejunal side of the gastroenterostomy we found shallow ulcerative lesions always single, well-defined and with variable diameter 3 to 6 mm, six times in the RY group and none in the RYTV group (RY>RYTV, p=0.008). Neoplastic or preneoplastic lesions were not diagnosed in all groups.

Conclusion: Truncal vagotomy is a safe and non-carcinogenic method in not resected and partially resected stomach.
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http://dx.doi.org/10.1590/S0102-86502014000200005DOI Listing
February 2014

[Defensive medicine: a necessary practice?].

Rev Col Bras Cir 2013 Nov-Dec;40(6):494-501

We discuss the reasons why Defensive Medicine is widely used in Brazil and worldwide. The Defensive Medicine is characterized by excessive use of complementary tests, the use of supposedly safer therapeutic procedures, the frequent referral of patients to other specialists and by the refusal to care for critically ill patients and with greater potential for complications. This is a practice that aims to defend the doctor from legal suits. The way the processes are conducted by the judiciary certainly contributes to the consolidation of this foolish practice. The slow pace of justice in our country, associated with the unpreparedness of judges and legal experts in the analysis of cases, leads to an emotional exhaustion of the parties involved. Furthermore, poor training of doctors in our country values the use of sophisticated diagnostic and treatment methods, rather than a thorough clinical examination and appropriate communication with the patient. Besides inefficient in protecting the doctor, Defensive Medicine has severe consequences to the patient and to society, since it generates an additional invaluable cost to medical practice, determines greater suffering to the patient and causes deterioration of the doctor-patient relationship, which has always been marked by trust, respect and personhood.
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http://dx.doi.org/10.1590/s0100-69912013000600013DOI Listing
April 2015

Efficacy of surgical versus conservative treatment in esophageal perforation: a systematic review of case series studies.

Acta Cir Bras 2013 Apr;28(4):266-71

Postgraduate Program in General Basis of Surgery, Botucatu School of Medicine, UNESP, Brazil.

Purpose: To evaluate the efficacy of surgical treatment for esophageal perforation.

Methods: A systematic review of the literature was performed. We conducted a search strategy in the main electronic databases such as PubMed, Embase and Lilacs to identify all case series.

Results: Thirty three case series met the inclusion criteria with a total of 1417 participants. The predominant etiology was iatrogenic (54.2%) followed by spontaneous cause (20.4%) and in 66.1% the localization was thoracic. In 65.4% and 33.4% surgical and conservative therapy, respectively, was considered the first choice. There was a statistically significance different with regards mortality rate favoring the surgical group (16.3%) versus conservative treatment (21.2%) (p<0.05).

Conclusion: Surgical treatment was more effective and safe than conservative treatment concerning mortality rates, although the possibility of bias due to clinical and methodological heterogeneity among the included studies and the level of evidence that cannot be ruled out.
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http://dx.doi.org/10.1590/s0102-86502013000400006DOI Listing
April 2013

Intestinal healing in rats submitted to ethanol ingestion.

Acta Cir Bras 2012 Mar;27(3):236-43

Division of Gastroenterology Surgery, Surgery and Orthopedics Department, Botucatu School of Medicine, UNESP, Brazil.

Purpose: To study the effect of alcoholism on intestinal healing and postoperative complications in rats

Methods: One hundred and sixty rats were divided into two groups: control and treated. The control group received water and the treated group 30% ethanol. After 180 days, colotomy with anastomosis were performed. After, the groups were divided into four subgroups: 20 rats for study at the following moments: 4(th), 7(th), 14(th) and 21(st) postoperative. The analyzed parameters were: weight gain, breaking strength, tissue hydroxyproline, postoperative complications and histopathological study

Results: Weight gain was greater in the control group (p<0.05). When all the subgroups were clustered, breaking strength was significantly greater in the control (p<0.05). Histopathology and hydroxyproline dosage did not show differences. There were five surgical site infections in the treated group while the control group showed two (p>0.05). Nine fistulas occurred in the treated group whereas the control group two (p<0.05). There were three deaths in the control group and seven in the treated group (p>0.05).

Conclusions: Treated group undergo a malnutrition process that is revealed by lower weight gain. Impaired intestinal healing as indicated by smaller breaking strength. There were a larger number of postoperative complications in the treated animals.
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http://dx.doi.org/10.1590/s0102-86502012000300006DOI Listing
March 2012

[Informed consent: what is it real value in medical practice?].

Rev Col Bras Cir 2011 May-Jun;38(3):198-201

Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Unesp, SP, BR.

This is an article that talks about the real importance of Informed Consent (IC) in medical practice. This document has been increasingly used as a defensive practice, in order to provide evidence to the defense of any lawsuit of medical responsibility, thus distorting the original idea, which would be to respect patient autonomy and delimit medical liability. The document aims to show that the doctor complied with his duty to inform. Its great value lies in cases where there is a risk of irreversible damage to the patient. We conclude, however, that a well-documented chart, which includes the recording of information that was provided and the degree of participation of patients and their families in treatment decisions, should also have legal and ethical value similar to the IC's.
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http://dx.doi.org/10.1590/s0100-69912011000300011DOI Listing
December 2011

[Management of chronic pain after inguinal hernioplasty].

Rev Col Bras Cir 2011 Jan-Feb;38(1):59-65

Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, UNESP, SP, BR.

Chronic groin pain after herniorrhaphy is a concern, as approximately 10% of patients undergoing inguinal hernia repair have symptoms, which often limit physical ability. The etiopathogenesis is related to periostitis pubis (somatic pain) and more often to nerve injury (neuropathic pain). It is clinically important to distinguish between these two types of pain because treatment can be different. The physician should establish a routine diagnosis and treatment, and most patients will need surgical approach. Prevention of this condition is of great importance and can lead to a lower incidence of the syndrome. Some measures are key, such as how to avoid application of stitches or clips to the pubis periosteum, using the prosthesis carefully and identifying the nerves in the groin. This last measure is certainly the most important in the prevention of chronic pain and involves thorough knowledge of anatomy and the use of refined technique.
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http://dx.doi.org/10.1590/s0100-69912011000100011DOI Listing
September 2011

Comparative study between two techniques of incisional hernia repair with polypropylene mesh in rabbits.

Acta Cir Bras 2010 Oct;25(5):423-7

Department of Surgery and Orthopedics, Botucatu Medical School, UNESP, Brazil.

Purpose: To compare two different incisional hernia repair techniques (repair with a polypropylene mesh reinforcement on the peritonium-aponeurosis versus polypropylene mesh sutured to the borders of the hernial ring as a bridge) in rabbits.

Methods: Incisional hernia was experimentally developed through a 4-cm median incision in 60 rabbits. After 30 days, half of the animals were operated for primary wall closure and placement of a polypropylene mesh reinforcement, while the other half had a polypropylene mesh sutured to the borders of the hernial ring as a bridge. Clinical development, scar breaking strength, as well as gross, microscopic and morphometric parameters were evaluated in all animals 30, 60, and 90 days after repair.

Results: No significant differences in breaking strength or histological parameters were observed between groups at any time point studied. No statistical difference regarding complications was detected, although denser and firmer adhesions to the abdominal wall were seen after the mesh was placed as a " bridge" .

Conclusions: No significant differences between the incisional hernia repair techniques assessed were observed regarding breaking strength, and histological and morphometric parameters. The number of complications was similar in both study groups. However, adhesion of abdominal cavity organs to the scar area was much denser after the placement of a mesh to bridge the defect.
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http://dx.doi.org/10.1590/s0102-86502010000500007DOI Listing
October 2010

[Prevention of medico-legal conflicts in medical practice].

Rev Col Bras Cir 2009 Feb;36(1):90-5

Departamento de Cirurgia e Ortopedia, Faculdade de Medicina de Botucatu, Unesp, SP, BR.

Generally, medico-legal conflicts which occur in surgical and medical practice are a source of worry for both the medical profession and the society as a whole, because on one hand, they could cause high emotional stress for doctors, and on the other hand, patients could be rejected. Once consolidated, defensive medicine increases treatment costs and the doctor-patient relationship could transform into a tragedy. There are many causes for this, including non-treatment factors, such as an unsupported and disorganized health system, lack of participation from society and the doctor in improving this system, the training machine which launches a large number of young unprepared doctors to practice in this noble profession, along with a lack of continuing training, as there are few public or private institutions providing preparation, or further medical training. The related treatment factors are generally, a deficient doctor-patient relationship, poor work condition, power abuse by the doctor, a lack of clear agreement, and poor medical record keeping. These conflicts cannot be solved by simple creating legislation, or by denying the existence of medical error, which occurs at higher frequency than the actual conflicts. It is very important to improve the doctor-patient relationship because an effective fraternal relationship reduces the chance of a judicial demand. The doctor still needs to fully understand his/her conduct obligations and mainly to avoid power abuse. Doctors must also professionally link themselves with politicians who fight for the individual's rights against the system. Society must also understand that health is not just an issue exclusive for doctors, and people must fight to improve living conditions. Society must seriously show its frustration with the increasing disparity between scientific possibilities and actual wellbeing. The training machine needs immediate profound changes to produce professionals with the highest qualifications equipped for the needs of our population.
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http://dx.doi.org/10.1590/s0100-69912009000100016DOI Listing
February 2009

[Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias].

Arq Gastroenterol 2009 Apr-Jun;46(2):121-6

Departamento de Cirurgia e Ortopedia, Disciplina de Gastroenterologia Cirúrgica da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil.

Context: Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications.

Objectives: To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall.

Methods: Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days.

Results: Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up.

Conclusion: Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.
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http://dx.doi.org/10.1590/s0004-28032009000200009DOI Listing
October 2009

[Inguinal hernia repair in children: importance of combined local anesthesia].

Arq Gastroenterol 2002 Jul-Sep;39(3):204-8. Epub 2003 May 21.

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brasil.

Aim: To describe an anesthetic technique, as well as the results of surgical treatment of the inguinal hernia in children.

Patients/methods: Forty-eight patients were submitted to inguinal hernia repair under local anesthesia at "Santa Casa de Misericórdia de Cerqueira César", State of São Paulo, Brazil. There were 34 male and 14 female patients, range from 3 months to 12 years old. Local anesthesia was performed with a dose of 5 mg/kg body weight of 1% lidocaine through iliohypogastric and ilioinguinal nerve blocks, medially to the anterior superior iliac spine, and at level of the pubic tubercle. Sedation was done with an association of ketamine (1 to 2 mg/kg) and diazepam (0,2 to 0,4 mg/kg).

Results: In all patients except one the procedure was done without complications. In that patient the local anesthesia was not effective and was followed by inhalatory anesthesia. Surgical complications (blood collections) were observed in three patients: two at the scrotum and one at subcutaneous, with good evolution.

Conclusions: We conclude that the use of local anesthesia associated to sedative is a simple and safe procedure for the inguinal hernia repair in children.
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http://dx.doi.org/10.1590/s0004-28032002000300012DOI Listing
June 2003
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