Intranodal Lymphangiography during Surgical Repair of Pelvic Lymphorrhea after Radical Cystectomy

Lymphorrhea can develop after various types of surgeries. Surgical closure of the lymphatic leakage point is an effective treatment option. However, it is difficult to identify the leakage point sometimes. Here, we report a case of pelvic lymphorrhea after radical cystectomy for bladder cancer. Identification of the leakage point was difficult during laparoscopic surgical repair of lymphorrhea. Intranodal lymphangiography was performed via the inguinal lymph node by injection of lipiodol, followed by injection of indigo carmine. Laparoscopy revealed extravasation of lipiodol and indigo carmine from the pelvic wall. The leakage point was successfully cauterized using an electric scalpel. Lymphorrhea improved after the surgical repair. This case suggests that intranodal lymphangiography may be useful for detecting the site of lymphatic leakage during the surgical repair of lymphorrhea.

Winged scapula following axillary thoracotomy with long thoracic nerve preservation

Winged scapula is a rare condition caused by injuries to the long thoracic nerve (LTN) and accessory nerves. A 69-year-old man underwent surgery for right lung cancer. Video-assisted thoracic surgery was converted to axillary thoracotomy at the fourth intercostal space. The latissimus dorsi was protected, and the serratus anterior was divided on the side anterior to the LTN. Two months after discharge, he presented with difficulty in elevating his right arm and protrusion of the scapula from his back. Active forward flexion of the right shoulder was limited to 110° and abduction to 130°. He was diagnosed with winged scapula. After 6 months of occupational therapy, the symptoms improved. The LTN may have been overstretched or damaged by the electric scalpel. We recommend an increased awareness of the LTN, and to divide the serratus anterior at a site as far as possible from the LTN to avoid postoperative winged scapula.

O uso seguro de eletrocirurgia

RESUMOObjetivo: identificar os requisitos necessários para a construção de um checklist voltado para a segurança em eletrocirurgia. Método: trata-se de um estudo quantitativo, descritivo, para a produção tecnológica, a ser desenvolvida em duas etapas. Identificar-se-ão, na primeira, os requisitos necessários, por meio de revisão integrativa, para o apoio ao processo de Enfermagem (cuidados de Enfermagem) em paciente submetidos a procedimentos cirúrgicos com o uso de eletrocirurgia. Desenvolver-se-á, na segunda etapa, um checklist de apoio ao processo de Enfermagem a partir dos requisitos identificados e eleitos na etapa anterior. Resultados esperados: pretende-se disponibilizar um checklist que sirva de ferramenta para o uso seguro do bisturi elétrico, assim como contribuir para a melhoria da qualidade da assistência de Enfermagem e, ainda, diminuir o número de injúrias causadas pelo mau uso desta tecnologia. Descritores: Eletrocirurgia; Enfermagem; Saúde; Cuidados de Enfermagem; Enfermagem Perioperatória; Eletrodos.ABSTRACT Objective: to identify the necessary requirements for the construction of a checklist for safety in electrosurgery. Method: this is a quantitative, descriptive study for technological production, to be developed in two stages. The first one will identify the necessary requirements, through an integrative review, to support the nursing process (nursing care) in a patient undergoing surgical procedures with the use of electrosurgery. A checklist of support to the Nursing process will be developed in the second stage, based on the requirements identified and elected in the previous stage. Expected results: it is intended to provide a checklist that serves as a tool for the safe use of the electric scalpel, as well as to contribute to the improvement of the quality of Nursing care and also to reduce the number of injuries caused by the misuse of this technology. Descriptors: Electrosurgery; Nursing; Cheers; Nursing care; Perioperative Nursing; Electrodes. RESUMENObjetivo: identificar los requisitos necesarios para la construcción de un checklist orientado a la seguridad en electrocirugía. Método: se trata de un estudio cuantitativo, descriptivo, para la producción tecnológica, que se desarrollará en dos etapas. Se identificará, en la primera, los requisitos necesarios, por medio de revisión integrativa, para el apoyo al proceso de Enfermería (cuidados de Enfermería) en paciente sometidos a procedimientos quirúrgicos con el uso de electrocirugía. Se desarrollará, en la segunda etapa, un checklist de apoyo al proceso de Enfermería a partir de los requisitos identificados y elegidos en la etapa anterior. Resultados esperados: se pretende disponer un checklist que sirva de herramienta para el uso seguro del bisturí eléctrico, así como contribuir a la mejora de la calidad de la asistencia de Enfermería y, además, disminuir el número de injurias causadas por el mal uso de esta tecnología. Descriptores: Electrocirugía; Enfermería; Salud; Cuidados de enfermería; Enfermería perioperatoria; Electrodos.

High Power Laser and Photobiomodulation in Oral Surgery: Case Report

Introduction: The labial frenum is a fold of mucous membrane that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. In some cases, its presence can cause a midline diastema, periodontal diseases related to food impaction, or retention of biofilm, among others. In such cases, lip frenectomy is indicated as treatment, which can be performed with a scalpel (conventional method), an electric scalpel, or a surgical laser. Objective: To show a clinical case performed at Laser Extension Project in Dentistry, Federal University of Maranhão grounded in a literature review. Case Presentation: A laser frenectomy was performed on a female patient, aged 20, who had a diastema between the upper central incisors and an indication for frenum removal. The high-power diode laser is excellent for procedures in soft tissue because its wavelength is well absorbed by hemoglobin and other pigments; its use also allows a reduction in the amount of anesthetic and medicines used. The parameters used were 2 W, in a continuous mode, 808 nm infrared emission; with delivery of the beam through optical fiber 300 μM; energy of 120 J; 20 pps. Conclusion: the high power diode laser allowed a satisfactory result, the procedure was safe, the technique was a simple one and of reduced clinical time, as mentioned in the literature. It is worth noting that the technique is dependent on the skill of the professional performing it.

THERAPEUTIC PARTICULARITIES OF CHRONIC SUPPURATED CHOLESTEATOMATOUS OTOMASTOIDITIS

Chronic suppurated otomastoiditis is a chronic inflammatory damage of the middle ear and mastoid process that exceeds 12 weeks and which leads to the permanent perforation of the eardrum’s membrane. There is local damage such as osteitis, osteonecrosis and cholesteatoma, while a general view reveals an asymptomatic evolution, with a good general state, otorrhea being the only local symptom. This paper brings to light a case resulting from the thorough analysis of case studies run by the ENT Clinic of the Emergency County Hospital "Sf. Apostol Andrei” of Galaţi, through the fact that otomastoiditis progresses given the presence of a congenital hemangioma located on the left half of the cephalic extremity, at a cervical, thoracic and abdominal level. The patient, aged 41, has been suffering from this disease since childhood and has undergone numerous surgeries up to this moment, but none has proven to be adequate for the extent of the lesion due to the malformation and the difficulty in providing general anesthesia with orotracheal intubation, the hemangioma being present in the oropharynx, hypopharynx and larynx. Given the overlapping of the two disorders, the surgical-medical approach to the ear damage has proven insufficient in time due to the risk of massive bleeding, taking into account the fact that the hemangioma was extended to the left ear duct, pharynx and larynx. For this reason, the disease has progressed, leading to extended erosive cholesteatoma with left otomastoiditis. The particularities of the therapeutic approach are presented along with anesthesiologic and surgical problems involved by the hemangioma. Although the risk of hemorrhaging was great, approaching the condition by choosing to provide general anesthesia and making the incisions only with the help of an electric scalpel, the case was eventually solved successfully from a surgical point of view.

O uso do bisturi elétrico e cuidados relacionados: revisão integrativa

Objetivo: Analisar evidências científicas sobre a utilização do bisturi elétrico e os cuidados relacionados ao uso desse equipamento. Método: Revisãointegrativa da literatura realizada em abril e maio de 2016 nas bases de dados PubMed (arquivo digital produzido pela National Library of Medicine),Biblioteca Virtual em Saúde (BVS) e Google Acadêmico. Para o levantamento de artigos, foram utilizados os descritores não controlados: bisturi elétricoe electric scalpel. Resultados: A estratégia de busca permitiu a análise de seis artigos que abordaram três temas principais: riscos associados ao uso dobisturi elétrico, conhecimento da equipe em relação ao uso do bisturi elétrico e papel do enfermeiro na prevenção de riscos associados à eletrocirurgia.Conclusão: Conclui-se que é necessário implementar ações para que enfermeiros e técnicos de enfermagem adquiram um nível adequado de conhecimentose habilidades relacionados à segurança do paciente submetido à eletrocirurgia.

TREATMENT OF DOGS WITH ORAL MELANOMA RECURRENCE BY DIODE LASER EXCISION

Introduction: Treatment of oral melanomas utilizes the surgical excision-resection (Culp et al., 2013) and/or radiation therapy (Proulx et al., 2003), chemotherapy with carboplatin (Brockley et al., 2013), immunotherapy (Ottnod et al., 2013). Treatment based on surgical excision is usually palliative (Freeman et al., 2003). Aims: In the literature even though there are data concerning the prognosis of oral melanomas in dogs after surgery, are missing data after laser excision. Taking into account these findings we wished to present our experience regarding three cases of oral melanoma recurrence and immediate and long term laser surgery results. Materials and Methods: The casuistry consisted of three dogs with recurrent oral malignant melanomas, subjected to surgical reintervention. The initial diagnosis was melanotic melanoma in stage I or II. The animals were brought back at different time intervals from originally excision with electric scalpel. Before reintervention, dogs were subjected to clinical, paraclinical exam and biopsy. Excision of the tumor mass was made with an optical fiber hawing a diameter of 400µm, at a power of 10W and a wavelength of 940 nm with a diode laser. At 1, 2, 3, 6 and 12 months after laser reintervention the dogs were reexamined. Results: Average time in which appeared canine oral melanoma relapse was 58.6 days. After reexamination all cases where reinstatement in stage I. Operators times were held in conditions of comfort with wide access, minimum bleeding, effective hemostasis. After surgery at 24 hours on the intervention place a slight local redness, without swelling and bleeding was observed. Palpation revealed initially also a slight local sensitivity which completely disappeared in 48 hours. There were no grasping and chewing disturbances. Macroscopic healing occurred in 7-9 days. At last recheck performed at 12 months there were no evidences of tumour recurrence or metastasis. Conclusion: Diode laser excision of oral malignant melanoma in dogs can be an alternative palliative procedure to invasive surgical resection procedures. The average of free recurrence and metastasis time after laser surgery has exceeded 360 days in these three cases.