http://repositorio.ufc.br/handle/riufc/427 2026-05-31T00:25:26Z http://repositorio.ufc.br/handle/riufc/86061 Título: Prevalência das disfunções do assoalho pélvico utilizando ultrassom 3D dinâmico em mulheres com sintomas de evacuação obstruída e sua relação com idade, paridade e parto vaginal Autor(es): Vilarinho, Adjra da Silva Abstract: Considerable controversy remains regarding the prevalence of pelvic floor disorders and their associated risk factors, largely due to biases related to the study populations and methodologies used. Few studies have employed dynamic three-dimensional imaging to identify pelvic floor dysfunctions and correlate them with factors such as mode of delivery, parity, or patient age. Therefore, this study aimed to determine the prevalence of pelvic floor disorders in female patients with obstructed defecation and to assess their association with age, mode of delivery, and parity using dynamic three-dimensional anorectal ultrasound (3D-US). This cohort study was conducted in the colorectal surgery unit of a tertiary hospital. Female patients presenting with symptoms of obstructed defecation who, despite increased dietary fiber intake, maintained a Cleveland Clinic Florida Constipation Score greater than 6 underwent echodefecography (EDF) to evaluate the presence of posterior pelvic floor dysfunction. The findings were then correlated with history of vaginal delivery, parity, and age. A total of 889 women were included: 552 (62%) had a history of vaginal delivery, and 337 (38%) were nulliparous. The mean age was significantly higher among women with a history of vaginal delivery. Previous anorectal surgeries were more frequent among nulliparous women (p = 0.043). The prevalence of posterior pelvic floor disorders—including rectocele, intussusception, enterocele/sigmoidocele, and anismus—was similar between the two groups and was not associated with the number of vaginal deliveries or with age. However, the prevalence of sphincter defects was higher in the vaginal delivery group and was positively associated with parity. In conclusion, the prevalence of obstructed defecation disorders such as rectocele, intussusception, and enterocele/sigmoidocele, as assessed by EDF, was not associated with vaginal delivery, number of deliveries, or age. Nevertheless, symptoms of fecal incontinence and obstructed evacuation were more prevalent among older women, regardless of prior vaginal deliveries. No association was found between age and the prevalence of sphincter defects in nulliparous women. Tipo: Tese 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/86013 Título: Resultados clínico-cirúrgicos e sobrevida de pacientes submetidos a gastroduodenopancreatectomias em um hospital universitário Autor(es): Martins, Tarso Buaiz Pereira Abstract: Pancreaticoduodenectomy (PD), a highly complex procedure, is the main treatment for resectable tumors of the pancreatic head and periampullary region. Advances in surgical and anesthetic techniques, together with perioperative intensive care, have reduced patient mortality over the past decades, although morbidity remains high. The main objectives of this study were to analyze the clinical and epidemiological characteristics, as well as the survival, of patients undergoing PD. This was a longitudinal, observational, and analytical study, with retrospective data collection from the medical records of 110 patients operated on between 2015 and 2023 at Hospital Universitário Walter Cantídio (HUWC/UFC). Logistic regression analysis identified the following as significant risk factors for death: male sex, dyslipidemia, smoking, histological diagnosis of pancreatic adenocarcinoma or cholangiocarcinoma, and the presence of positive lymph nodes. Perioperative mortality (30 days) was 3.63%, and estimated overall survival was 75.5% at 6 months, 68% at 12 months, 64% at 3 years and 58% at 5 years, with a median overall survival of 48.53 months. Regarding postoperative complications, a high morbidity rate was observed, affecting 83.6% of patients. The main complications identified were infections (60.9%), pancreatic fistula (41.8%), delayed gastric emptying (25.4%), and bleeding (22.7%). Less frequent complications included pulmonary complications (6.3%) and biliary fistula (4.5%). The results of this case series, with in-hospital mortality below 5%, were similar to those reported by major international centers. HUWC is a center for teaching, research, and patient care, and these data are essential to support protocols and contribute to optimizing survival and reducing morbidity in these major surgical procedures. Tipo: Dissertação 2026-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/84911 Título: Talipes equinovarus congênito e tálus vertical congênito decorrente de doença do corno anterior da medula espinhal: lições da síndrome congênita associada a infecção pelo vírus Zika Autor(es): Colares, Paulo Giordano Baima Abstract: ABSTRACT Idiopathic congenital talipes equinovarus (iCTEV) and congenital vertical talus (CVT) are structural foot deformities whose etiologies remain incompletely understood. Clinical and histopathological findings described in classic cases have long raised the possibility of neurogenic mechanisms involving the anterior horn of the spinal cord. Similarly, neurogenic arthrogryposis multiplex congenita (AMC) is characterized by congenital joint contractures and muscular and medullary patterns compatible with early motor neuron impairment. Congenital Zika Syndrome (CZS), in turn, represents a contemporary model of congenital viral injury to the central and peripheral nervous systems, including selective neural depletion and calcification of the anterior horn of the spinal cord, frequently associated with foot deformities. Given these convergences, this study aimed to describe and analyze congenital foot deformities in patients with CZS, with clinical, etiological, and pathophysiological emphasis, to support the hypothesis of anterior horn injury as an etiological factor in orthopedic deformities. Secondarily, it illustrates clinical, anatomopathological, and histopathological findings from two pre-Zika stillborns diagnosed with iCTEV and CVT, compares these findings with those observed in CZS and neurogenic AMC, and describes additional foot deformities identified in this case series. Thus, an observational, descriptive, prospective, uncontrolled study was conducted, composed of two complementary subgroups. Subgroup 1 included a coorte of children with CZS followed between December 2016 and June 2019 in a multidisciplinary clinic in Fortaleza, Ceará, with 30-month follow-up and semiannual clinical and radiographic evaluations. Subgroup 2 consisted of an illustrative retrospective analysis of two pre-2015 stillborns with bilateral iCTEV and CVT who underwent autopsy. The evaluation included macroscopic examination of the lumbar spine, histologic analysis of the lumbar spinal cord and lower-limb muscles, and documentation of “ghost fascicles” as well as neural depletion and calcification of the anterior horn. Orthopedic clinical assessments were performed by a team of three pediatric orthopedic surgeons. Among 130 patients with CZS, 11 (8.46%) presented isolated rigid iCTEV, isolated CVT, or both deformities; four (3.08%) met diagnostic criteria for AMC. The pre-Zika iCTEV case showed neural depletion and spinal cord calcification, while both pre-Zika cases exhibited muscular patterns with “ghost fascicles”, characteristic of neurogenic atrophy, similar to those observed in neurogenic AMC and CZS. The foot deformities identified demonstrate a clinical and pathophysiological pattern consistent with motor neuron injury of the anterior horn. The analysis of pre-Zika cases reinforces etiological similarities among iCTEV/CVT, neurogenic AMC, and CZS. The diversity of deformities observed in CZS suggests focal spinal cord involvement capable of producing multiple orthopedic phenotypes. These findings support the hypothesis of a neurogenic etiology for iCTEV and CVT—or at least for a subset of cases—and indicate new directions for etiological, diagnostic, and preventive investigation. Tipo: Tese 2025-01-01T00:00:00Z http://repositorio.ufc.br/handle/riufc/83521 Título: Matriz descelularizada (Scaffold) de pele de tilápia (Oreochromis niloticus) como substituto da túnica albugínea para cirurgias penianas reconstrutivas em ratos Wistar (Rattus norvegicus) Autor(es): Mesquita, Francisco José Cabral Abstract: The repair of tunica albuginea severe conditions, such as Peyronie's disease (PD), often requires reconstructive techniques, including the use of tissue substitutes. Despite advances, the ideal graft is still being sought. This study aimed to evaluate the biocompatibility and inflammatory process of a decellularized tilapia (Oreochromis niloticus) skin scaffold as a substitute for the tunica albuginea in penile reconstructive surgery in Wistar rats (Rattus norvegicus). The scaffold’s effects were assessed through histological evaluation and quantification of vascular density via CD31 immunoexpression.. A surgical incision was made in the tunica albuginea layer of the penile shaft in 36 rats. , They were separated into three groups: Negative Control - Sham: a fragment of the tunica albuginea itself sutured in the original location; Positive Control: reconstruction with a bovine pericardial membrane (Biopatch®); Test Group: Reconstruction with decellularized tilapia skin scaffold. After 15 days, the animals were euthanized and the penile tissue was harvested for analysis. Histopathological analysis demonstrated that the Sham Group exhibited preserved anatomical architecture of the tunica albuginea layer and corpora cavernosa tissue; the Positive Control Group showed an intense inflammatory response, with mixed leukocyte infiltration, multinucleated giant cells, and areas of necrosis, in addition to areas of rupture suggesting pronounced inflammatory response to the material; and Test Group showed maintaince of vascular spaces in the corpora cavernosa along with its lack of significant inflammation. In immunohistochemical analysis, the Positive Group showed greater vascular density (angiogenesis) compared to the other groups (p<0.001), indicating a more intense inflammatory response. The analysis of the results disclose that the decellularized tilapia skin matrix has promising potential as a substitute for the tunica albuginea in penile reconstructive surgeries. The biocompatibility of the tilapia scaffold, the absence of marked inflammation, and the preservation of vascular spaces suggest that the biomaterial can promote tissue regeneration and the restoration of penile function, proving to be a promising alternative to bovine pericardium. Tipo: Tese 2025-01-01T00:00:00Z