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Challenges to implement laparoscopic appendectomy as the first-line treatment for acute appendicitis: a fifteen-year experience in a tertiary hospital in Brazil
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DAMOUS, SERGIO HENRIQUE BASTOS

; MENEGOZZO, CARLOS AUGUSTO METIDIERI

; ROCHA, MARCELO CRISTIANO

; COLLET-E-SILVA, FRANCISCO SALLES

; UTIYAMA, EDIVALDO MASSAZO

Revista do Colégio Brasileiro de Cirurgiões

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2023, Volume 50 elocation e20233527

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

ABSTRACT Background: the barriers to implement emergency laparoscopy in public teaching hospitals involve issues such as resident learning curves and resource costs and availability. This study was designed to describe the issues facing the implementation of laparoscopic approach for acute appendicitis over 15 years in a single academic center in Brazil. Materials and Methods: retrospective study of patients undergoing emergency appendectomy from 2004 to 2018. Clinical data were compared to four major actions implemented in the emergency surgical service: minimally invasive surgery training for residents (2007), laparoscopic stump closure using metal clips (2008), 24/7 availability of laparoscopic instruments for emergency surgeries (2010), and third-party contract for maintenance of the laparoscopic instruments and implementation of polymeric clips for stump closure (2013). We evaluated the increase in laparoscopic appendectomy after the implementation of those major changes. Results: we identified 1168 appendectomies during the study period, of which 691 (59%), 465 (40%), and 12 (1%) were open, laparoscopic, and converted, respectively. The implementation of the major changes since 2004 resulted in an increase of laparoscopic appendectomies from 11% in 2007 to 80% in 2016. These actions were decisive in the widespread use of laparoscopy for acute appendicitis (p<0.001). The standardization of the hem-o-lok clip in the treatment of the appendiceal stump made the procedure more feasible, reducing the surgical time using laparoscopic access and increasing the team’s adherence, so that this became the route of choice in about 85% of cases in the period from 2014 to 2018, 80% performed by 3rd year resident physicians. No intraoperative complications were noted related to laparoscopic access, even in more complicated appendicitis. There was no mortality reported, no reoperations or readmissions to hospital during a 30-day postoperative period. Conclusion: the development of a feasible, reproducible, and safe technical standardization, associated with continuous cost optimization, are the cornerstones for a consistent and viable change in the current practice for appendectomies in middle and lower-income countries.

RESUMO Introdução: o presente estudo tem como objetivo avaliar as medidas que permitiram a implementação de cirurgias laparoscópicas de urgência em hospital de ensino médico ao longo de 15 anos. Método: foi realizado estudo clínico retrospectivo de pacientes submetidos a Apendicectomia aberta ou Laparoscópica no período de 15 anos (2004 a 2018). Os dados clínicos foram confrontados com as ações implementadas: 1) Treinamento dos médicos residentes em cirurgia minimamente invasiva (2007); 2) Uso do endoclip para tratamento do coto apendicular (2008); 3) Disponibilidade do set de laparoscopia em tempo integral para o Pronto Socorro (2010); e, 4) Terceirização do serviço de manutenção do set e materiais de vídeo e uso do endoclip Hem-o-lok® para tratamento do coto apendicular (2013). Resultados: foram realizadas 1.168 cirurgias, das quais 691 abertas (59%), 465 laparoscopias (40%) e 12 convertidas (1%). O treinamento da equipe levou à realização de 11% de laparoscopia (2007) e o uso do endoclip para tratamento do coto apendicular para 16% (2008). Com a disponibilização do set de vídeo em tempo integral para o Pronto Socorro a partir de 2011, houve aumento de laparoscopias para 26% (2012). A padronização do endoclip Hem-o-lok® no tratamento do coto apendicular aumentou para 85% e a partir de 2016 foi realizado em todos os casos, sem complicação relacionada ao seu uso, mesmo em apendicites complicadas. Conclusão: o emprego da laparoscopia no serviço de urgência envolve além do treinamento da equipe cirúrgica, investimento tecnológico contínuo e uso de técnicas que sejam factíveis, viáveis e seguras.

https://doi.org/10.1590/0100-6991e-20233527-en

Laparoscopy in Trauma: Can Brazil fit into the global trend? Trauma trend
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DAMOUS, SERGIO HENRIQUE BASTOS

; MENEGOZZO, CARLOS AUGUSTO METIDIERI

; VON-BAHTEN, LUIZ CARLOS

; UTIYAMA, EDIVALDO MASSAZO

Revista do Colégio Brasileiro de Cirurgiões

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2023, Volume 50 elocation e20233602EDIT01

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/0100-6991e-20233602edit01-en

Safe ultrasound-guided percutaneous tracheostomy in eight steps and necessary precautions in COVID-19 patients
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MENEGOZZO, CARLOS AUGUSTO METIDIERI

; SORBELLO, CAROLINA CARVALHO JANSEN

; SANTOS-JR, JONES PESSOA

; RASSLAN, ROBERTO

; DAMOUS, SERGIO HENRIQUE BASTOS

; UTIYAMA, EDIVALDO MASSAZO

Revista do Colégio Brasileiro de Cirurgiões

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2022, Volume 49 elocation e20223202

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO A traqueostomia percutânea tem sido considerada o método padrão atualmente, sendo a técnica guiada por broncoscopia a mais realizada. Uma alternativa segura é a traqueostomia percutânea guiada por ultrassonografia, que pode ser feita pelo próprio cirurgião, evitando-se as dificuldades logísticas de disponibilidade de um especialista em broncoscopia. Estudos comprovam que a eficácia e a segurança da técnica guiada por ultrassonografia, comparada à guiada por broncoscopia, são semelhantes. Assim, é de suma importância que os cirurgiões tenham a traqueostomia percutânea guiada por ultrassonografia como alternativa viável e benéfica em relação ao procedimento aberto. Neste artigo, descrevemos oito passos principais da realização da traqueostomia percutânea ecoguiada, destacando pontos técnicos essenciais que podem reduzir o risco de complicações do procedimento. Ainda, detalhamos alguns cuidados que devem ser observados, com o intuito de reduzir o risco de aerolização e contaminação da equipe, quando a traqueostomia percutânea é indicada no paciente com COVID-19.

ABSTRACT Percutaneous tracheostomy has been considered the standard method today, the bronchoscopy-guided technique being the most frequently performed. A safe alternative is ultrasound-guided percutaneous tracheostomy, which can be carried out by the surgeon, avoiding the logistical difficulties of having a specialist in bronchoscopy. Studies prove that the efficacy and safety of the ultrasound-guided technique are similar when compared to the bronchoscopy-guided one. Thus, it is of paramount importance that surgeons have ultrasound-guided percutaneous tracheostomy as a viable and beneficial alternative to the open procedure. In this article, we describe eight main steps in performing ultrasound-guided percutaneous tracheostomy, highlighting essential technical points that can reduce the risk of complications from the procedure. Furthermore, we detail some precautions that one must observe to reduce the risk of aerosolization and contamination of the team when percutaneous tracheostomy is indicated in patients with COVID-19.

https://doi.org/10.1590/0100-6991e-20223202

Predictive factors of mortality in patients with pelvic fracture and shock submitted to extraperitoneal pelvic packing
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FONSECA, VINICIUS CORDEIRO

; MENEGOZZO, CARLOS AUGUSTO METIDIERI

; CARDOSO, JULIANA MYNSSEN DA FONSECA

; BERNINI, CELSO OLIVEIRA

; UTIYAMA, EDIVALDO MASSAZO

; POGGETTI, RENATO SÉRGIO

Revista do Colégio Brasileiro de Cirurgiões

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2022, Volume 49 elocation e20223259

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Introdução: nas últimas décadas, tem sido difundida a técnica de tamponamento pélvico extraperitoneal, porém ainda existem poucos estudos. Decidiu-se analisar os resultados do tamponamento extraperitoneal de pelve, em pacientes com fratura pélvica e choque, com objetivo de identificar fatores preditivos de mortalidade. Métodos: foi realizada revisão do prontuário dos pacientes submetidos ao tamponamento extraperitoneal de pelve. Foram analisadas as características dos pacientes, dados do atendimento pré-hospitalar e na sala de emergência, classificação da fratura, presença de lesões associadas, exames laboratoriais e de imagem, dados relativos ao tamponamento, e outros procedimentos realizados, complicações, parâmetros hemodinâmicos e quantidade de hemoderivados transfudidos. Resultados: foram analisados os dados de 51 pacientes, com sinais de choque desde o atendimento pré-hospitalar, presença de acidose, elevado déficit de bases e lactato arterial. Houve alta prevalência de lesões graves associadas, requerendo múltiplos procedimentos cirúrgicos. A incidência de coagulopatia foi 70,58% e mortalidade 56,86%. O grupo de pacientes não sobreviventes apresentou idade e intubação orotraqueal pré-hospitalar maiores, e escores na escala de coma de Glasgow menores (p<0,05). O mesmo grupo apresentou, antes e após o tamponamento extraperitoneal de pelve, parâmetros hemodinâmicos menores de pressão arterial média, pH, déficit de bases e hemoglobina, e maior de lactato arterial (p<0,05). O grupo de pacientes não sobreviventes recebeu mais concentrados de hemácias, plasma fresco congelado e concentrado de plaquetas nas 24h seguintes ao tamponamento extraperitoneal de pelve (p<0,05). Conclusão: idade e o excesso de bases são fatores preditivos independentes de mortalidade em pacientes submetidos ao tamponamento extraperitoneal de pelve.

ABSTRACT Introduction: in recent decades, the extraperitoneal pelvic packing technique has been disseminated, but there are still few studies. Thus, it was decided to analyze the results of extraperitoneal pelvic tamponade, in patients with pelvic fracture and shock, in order to identify predictive factors for mortality. Methods: a retrospective review of medical records of patients submitted to extraperitoneal pelvic packing was conduced. We analyzed their characteristics, prehospital and emergency room data, pelvic fracture classification, associated and severity injuries, laboratory and imaging exams, data on packing, arteriography, and other procedures performed, complications, hemodynamic parameters, and amount of transfused blood products before and after packing. Results: data were analyzed from 51 patients, who showed signs of shock from prehospital care, presence of acidosis, with high base deficit and arterial lactate levels. Most patients underwent multiple surgical procedures due to severe associated injuries. The incidence of coagulopathy was 70.58%, and overall mortality was 56.86%. The group of non-surviving patients presented significantly higher age, prehospital endotracheal intubation, and lower Glasgow Coma Scale scores (p<0.05). The same group presented, before and after extraperitoneal pelvic packing, significantly worse hemodynamic parameters of mean arterial pressure, pH, base deficit, hemoglobin, and arterial lactate (p<0.05). The non-surviving group received significantly more units of packed red blood cells, fresh frozen plasma and platelets within 24 hours following extraperitoneal pelvic packing (p<0.05). Conclusion: age and base deficit are independent predictors of mortality in patients submitted to extraperitoneal pelvic packing.

https://doi.org/10.1590/0100-6991e-20223259-en

Transfusion of ABO non-identical platelets increases the severity of trauma patients at ICU admission
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Silva, Adriana Lucia de Oliveira

; Bassolli, Lucas

; Ferreira, Pedro

; Utiyama, Edivaldo

; Dezan, Marcia Regina

; Costa-Neto, Abel

; Conrado, Marina C.A.V

; Oliveira, Valeria Brito

; Bonifácio, Silvia Leão

; Fernandes, Frederico Leon Arrabal

; Rocha, Vanderson

; Mendrone-Júnior, Alfredo

; Dinardo, Carla Luana

Hematology, Transfusion and Cell Therapy

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Set 2021, Volume 43 Nº 3 Páginas 287 - 294

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Transfusion of ABO-compatible non-identical platelets (PTLs), fresh plasma (FP) and red blood cells (RBCs) has been associated with increased morbidity and mortality of recipients. Trauma victims are frequently exposed to ABO non-identical products, given the need for emergency transfusions. Our goal was to evaluate the impact of the transfusion of ABO non-identical blood products on the severity and all-cause 30-day mortality of trauma patients. Methods: This was a retrospective single-center cohort, which included trauma patients who received emergency transfusions in the first 24 h of hospitalization. Patients were divided in two groups according to the use of <3 or ≥3 ABO non-identical blood products. The patient severity, measured by the Acute Physiology and Chronic Health Evaluation (APACHEII) score at ICU admission, and the 30-day mortality were compared between groups. Results: Two hundred and sixteen trauma patients were enrolled. Of these, 21.3% received ≥3 ABO non-identical blood products (RBCs, PLTs and FP or cryoprecipitate). The transfusion of ≥3 ABO non-identical blood products in the first 24 h of hospitalization was independently associated with a higher APACHEII score at ICU admission (OR = 3.28 and CI95% = 1.48–7.16). Transfusion of at least one unit of ABO non-identical PTLs was also associated with severity (OR = 10.89 and CI95% = 3.38–38.49). Transfusion of ABO non-identical blood products was not associated with a higher 30-day mortality in the studied cohort. Conclusion: The transfusion of ABO non-identical blood products and, especially, of ABO non-identical PLTs may be associated with the greater severity of trauma patients at ICU admission. The transfusion of ABO non-identical blood products in the trauma setting is not without risks.

https://doi.org/10.1016/j.htct.2020.06.011 17 downloads

Non-operative management of blunt splenic trauma: evolution, results and controversies
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MEIRA JÚNIOR, JOSÉ DONIZETI

; MENEGOZZO, CARLOS AUGUSTO METIDIERI

; ROCHA, MARCELO CRISTIANO

; UTIYAMA, EDIVALDO MASSAZO

Revista do Colégio Brasileiro de Cirurgiões

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2021, Volume 48 elocation e20202777

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO O baço é um dos órgãos mais frequentemente afetados no trauma abdominal contuso. Desde os trabalhos de Upadhyaya, o tratamento do trauma esplênico vem sofrendo importantes modificações. Atualmente, é consenso que todo trauma esplênico que se apresenta com estabilidade hemodinâmica pode ser tratado inicialmente de forma não operatória, desde que o serviço possua estrutura adequada e o paciente não apresente outras condições que indiquem exploração da cavidade abdominal. Entretanto, vários tópicos permanecem controversos no que diz respeito ao tratamento não operatório (TNO) do trauma esplênico. A angioembolização esplênica é uma ferramenta de grande auxílio no TNO, porém não há consenso sobre suas indicações precisas. Não há uma definição na literatura a respeito da forma como o TNO deve ser conduzido, tampouco a respeito da periodicidade do controle hematimétrico, do limiar de transfusão que define falha do TNO, de quando iniciar a profilaxia contra tromboembolismo venoso, da necessidade de exames de imagem de controle, do período de repouso no leito, e de quando é seguro indicar alta hospitalar. O objetivo desta revisão é analisar de forma crítica a literatura a respeito desse tema, expondo o estado da arte no TNO do trauma esplênico.

ABSTRACT The spleen is one of the most frequently affected organs in blunt abdominal trauma. Since Upadhyaya, the treatment of splenic trauma has undergone important changes. Currently, the consensus is that every splenic trauma presenting with hemodynamic stability should be initially treated nonoperatively, provided that the hospital has adequate structure and the patient does not present other conditions that indicate abdominal exploration. However, several topics regarding the nonoperative management (NOM) of splenic trauma are still controversial. Splenic angioembolization is a very useful tool for NOM, but there is no consensus on its precise indications. There is no definition in the literature as to how NOM should be conducted, neither about the periodicity of hematimetric control, the transfusion threshold that defines NOM failure, when to start venous thromboembolism prophylaxis, the need for control imaging, the duration of bed rest, and when it is safe to discharge the patient. The aim of this review is to make a critical analysis of the most recent literature on this topic, exposing the state of the art in the NOM of splenic trauma.

https://doi.org/10.1590/0100-6991e-20202777 955 downloads

Use and misuse of biomarkers and the role of D-dimer and C-reactive protein in the management of COVID-19: A post-hoc analysis of a prospective cohort study
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Gonçalves, Fabio Augusto Rodrigues

; Besen, Bruno Adler Maccagnan Pinheiro

; Lima, Clarice Antunes de

; Corá, Aline Pivetta

; Pereira, Antônio José Rodrigues

; Perazzio, Sandro Félix

; Gouvea, Christiane Pereira

; Fonseca, Luiz Augusto Marcondes

; Trindade, Evelinda Marramon

; Sumita, Nairo Massakazu

; Duarte, Alberto José da Silva

; Lichtenstein, Arnaldo

; Bonfa, Eloisa

; Utiyama, Edivaldo M.

; Segurado, Aluisio C.

; Perondi, Beatriz

; Miethke-Morais, Anna

; Montal, Amanda C.

; Harima, Leila

; Fusco, Solange R. G.

; Silva, Marjorie F.

; Rocha, Marcelo C.

; Marcilio, Izabel

; Rios, Izabel Cristina

; Kawano, Fabiane Yumi Ogihara

; Jesus, Maria Amélia de

; Kallas, Ésper George

; Carmo, Carolina

; Tanaka, Clarice

; Souza, Heraldo Possolo de

; Marchini, Julio F. M.

; Carvalho, Carlos

; Ferreira, Juliana C.

; Levin, Anna Sara Shafferman

; Oliveira, Maura Salaroli

; Guimarães, Thaís

; Lázari, Carolina dos Santos

; Sabino, Ester

; Magri, Marcello M. C.

; Barros-Filho, Tarcisio E. P.

; Francisco, Maria Cristina Peres Braido

; Costa, Silvia F.

Clinics

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2021, Volume 76 elocation e3547

Resumo: En | Texto: En | PDF: En

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is associated with high mortality among hospitalized patients and incurs high costs. Severe acute respiratory syndrome coronavirus 2 infection can trigger both inflammatory and thrombotic processes, and these complications can lead to a poorer prognosis. This study aimed to evaluate the association and temporal trends of D-dimer and C-reactive protein (CRP) levels with the incidence of venous thromboembolism (VTE), hospital mortality, and costs among inpatients with COVID-19. METHODS: Data were extracted from electronic patient records and laboratory databases. Crude and adjusted associations for age, sex, number of comorbidities, Sequential Organ Failure Assessment score at admission, and D-dimer or CRP logistic regression models were used to evaluate associations. RESULTS: Between March and June 2020, COVID-19 was documented in 3,254 inpatients. The D-dimer level ≥4,000 ng/mL fibrinogen equivalent unit (FEU) mortality odds ratio (OR) was 4.48 (adjusted OR: 1.97). The CRP level ≥220 mg/dL OR for death was 7.73 (adjusted OR: 3.93). The D-dimer level ≥4,000 ng/mL FEU VTE OR was 3.96 (adjusted OR: 3.26). The CRP level ≥220 mg/dL OR for VTE was 2.71 (adjusted OR: 1.92). All these analyses were statistically significant (p<0.001). Stratified hospital costs demonstrated a dose-response pattern. Adjusted D-dimer and CRP levels were associated with higher mortality and doubled hospital costs. In the first week, elevated D-dimer levels predicted VTE occurrence and systemic inflammatory harm, while CRP was a hospital mortality predictor. CONCLUSION: D-dimer and CRP levels were associated with higher hospital mortality and a higher incidence of VTE. D-dimer was more strongly associated with VTE, although its discriminative ability was poor, while CRP was a stronger predictor of hospital mortality. Their use outside the usual indications should not be modified and should be discouraged.

https://doi.org/10.6061/clinics/2021/e3547

Standardization of elective tracheostomies at the Central Institute of the Hospital das Clínicas in São Paulo during the COVID-19 pandemic
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MENEGOZZO, CARLOS AUGUSTO METIDIERI

; ARAP, SÉRGIO SAMIR

; MARIANI, ALESSANDRO WASUM

; MINAMOTO, HÉLIO

; IMAMURA, RUI

; BENTO, RICARDO FERREIRA

; PÊGO-FERNANDES, PAULO MANOEL

; KOWALSKI, LUIZ PAULO

; UTIYAMA, EDIVALDO MASSAZO

Revista do Colégio Brasileiro de Cirurgiões

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2020, Volume 47 elocation e20202574

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO A pandemia da COVID-19 tem gerado um número elevado de internações hospitalares e muitos pacientes são admitidos nas unidades de terapia intensiva para suporte ventilatório invasivo. A pneumonia viral provocada pelo Sars-cov-2 pode resultar na síndrome da disfunção respiratória aguda (SDRA) e em um tempo prolongado de ventilação mecânica, gerando uma demanda maior de traqueostomias. Diante do alto potencial de aerossolização desse procedimento, com risco de contaminação da equipe e do ambiente, é necessário criar uma padronização específica de todo o processo que envolve essa cirurgia. Este artigo visa demonstrar as principais etapas dessa padronização desenvolvida por um equipe dedicada à realização de traqueostomias em um hospital terciário dedicado ao atendimento de pacientes com suspeita ou confirmação de COVID-19.

ABSTRACT The COVID-19 Pandemic has resulted in a high number of hospital admissions and some of those patients need ventilatory support in intensive care units. The viral pneumonia secondary to Sars-cov-2 infection may lead to acute respiratory distress syndrome (ARDS) and longer mechanical ventilation needs, resulting in a higher demand for tracheostomies. Due to the high aerosolization potential of such procedure, and the associated risks of staff and envoirenment contamination, it is necesseray to develop a specific standardization of the of the whole process involving tracheostomies. This manuscript aims to demonstrate the main steps of the standardization created by a tracheostomy team in a tertiary hospital dedicated to providing care for patients with COVID-19.

https://doi.org/10.1590/0100-6991e-20202574 2163 downloads

Does a bilateral polypropylene mesh alter the duct deferens morphology, testicular size and testosterone levels? Experimental study in rats
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Damous, Sérgio Henrique Bastos

; Damous, Luciana Lamarão

; Miranda, Jocielle dos Santos

; Montero, Edna Frasson de Souza

; Birolini, Cláudio

; Utiyama, Edivaldo Massazo

Acta Cirúrgica Brasileira

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2020, Volume 35 Nº 2 elocation e202000201

Resumo: En | Texto: En | PDF: En

Abstract Purpose To evaluate the effect of a PP mesh on duct deferens morphology, testicular size and testosterone levels. Methods Forty adult male rats were distributed into groups: 1) no surgery; 2) inguinotomy; 3) mesh placed on the duct deferens; and 4) mesh placed on the spermatic funiculus. After 90 postoperative days, the inguinal region was resected, and blood samples were collected for the measurement of serum testosterone (pg/dl). The ducts deferens were sectioned in three axial sections according to the relationship with the mesh — cranial, medial and caudal. The wall thickness and duct deferens lumen area were measured. Results The morphology of the duct deferens was preserved in all groups. The mesh placement did not alter this morphology in any of the analyzed segments. Surgery, with or without mesh placement, did not alter the morphology, wall thickness or lumen area (p>0.05). In all operated groups, serum testosterone levels were similar (p>0.05) but there was a decrease in testicle size (p<0.05). Conclusion Surgery, with or without mesh placement, did not alter the morphology of the duct deferens and, although this treatment resulted in testicular size reduction, it did not affect serum testosterone levels.

https://doi.org/10.1590/s0102-865020200020000001 605 downloads

10.

Gynecology and women’s health care during the COVID-19 pandemic: Patient safety in surgery and prevention
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Soares-Júnior, José Maria

; Sorpreso, Isabel C.E.

; Motta, Eduardo Vieira

; Utiyama, Edivaldo Massazo

; Baracat, Edmund Chada

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2020, Volume 75 elocation e2063

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2063 1477 downloads

11.

Overcoming barriers to providing comprehensive inpatient care during the COVID-19 pandemic
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Miethke-Morais, Anna

; Perondi, Beatriz

; Harima, Leila

; Montal, Amanda C.

; Baldassare, Renato Madrid

; Moraes, Danielle P.

; Pedroso, Lucila

; Ramos, Marcelo C.A.

; Fusco, Solange R.G.

; Pereira, Antonio José

; Barros-Filho, Tarcísio E.P.

; Bonfá, Eloisa

; Utiyama, Edivaldo M.

; Segurado, Aluisio C.

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2020, Volume 75 elocation e2100

Resumo: En | Texto: En | PDF: En

https://doi.org/10.6061/clinics/2020/e2100 1240 downloads

12.

Prospective Analysis of Short- and Mid-term Knowledge Retention after a Brief Ultrasound Course for Undergraduate Medical Students
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Menegozzo, Carlos Augusto M.

; Cazolari, Priscila Gadelho

; Novo, Fernando da Costa Ferreira

; Colleoni, Ramiro

; Utiyama, Edivaldo Massazo

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2019, Volume 74 elocation e1087

Resumo: En | Texto: En | PDF: En

OBJECTIVES: The benefits of implementing point-of-care ultrasound (POCUS) in the emergency department are well established. Ideally, physicians should be taught POCUS during medical school. Several different courses have been designed for that purpose and have yielded good results. However, medical students need specifically designed courses that address the main objectives of knowledge acquisition and retention. Despite that, there is limited evidence to support knowledge retention, especially in the mid-term. The purpose of this study is to evaluate short- and mid-term knowledge retention after a student-aimed ultrasound course. METHODS: Medical students participating in a medical student trauma symposium (SIMPALT) in 2017 were included. Their profiles and baseline ultrasound knowledge were assessed by a precourse questionnaire (PRT). The same questionnaire was used one week (1POT) and three months (3POT) after the course. RESULTS: Most of the participants were 1st- to 4th- year medical students. None had prior ultrasound knowledge. They reported costs as the major barrier (65%) to enrollment in an ultrasound course. A comparison between the PRT and 1POT results showed a statistically significant difference (p<0.02), while no difference was found between 1POT and 3POT (p>0.09). CONCLUSION: Our findings support the use of a tailored ultrasound course for medical students. Knowledge acquisition and mid-term retention may be achieved by this specific population.

https://doi.org/10.6061/clinics/2019/e1087 275 downloads

13.

Outcomes of Elderly Patients Undergoing Emergency Surgery for Complicated Colorectal Cancer: A Retrospective Cohort Study
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Menegozzo, Carlos Augusto Metidieri

; Teixeira-Júnior, Frederico

; Couto-Netto, Sérgio Dias do

; Martins-Júnior, Octacílio

; Bernini, Celso de Oliveira

; Utiyama, Edivaldo Massazo

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2019, Volume 74 elocation e1074

Resumo: En | Texto: En | PDF: En

OBJECTIVE: Colorectal cancer is one of the most frequent types of malignant neoplasms. Age is a risk factor for this disease, with 75% of cases diagnosed in patients older than 65 years. Complications such as obstruction, hemorrhage, and perforation are present in more than one-third of cases and require emergency treatment. We aim to analyze the profile of elderly patients undergoing surgery for complicated colorectal cancer, and to evaluate factors related to worse short-term prognosis. METHODS: A retrospective analysis of patients who underwent emergency surgical treatment for complicated colorectal cancer was performed. Demographics, clinical, radiological and histological data were collected. RESULTS: Sixty-seven patients were analyzed. The median age was 72 years, and almost half (46%) of the patients were female. Obstruction was the most prevalent complication at initial presentation (72%). The most common sites of neoplasia were the left and sigmoid colon in 22 patients (32.8%), and the right colon in 17 patients (25.4%). Resection was performed in 88% of cases, followed by primary anastomosis in almost half. The most frequent clinical stages were II (48%) and III (22%). Forty-three patients (65.7%) had some form of postoperative complication. Clavien-Dindo grades 1, 2, and 4, were the most frequent. Complete oncologic resection was observed in 80% of the cases. The thirty-day mortality rate was 10.4%. Advanced age was associated with worse morbidity and mortality. CONCLUSION: Elderly patients with complicated colorectal cancer undergoing emergency surgery have high morbidity and mortality rates. Advanced age is significantly associated with worse outcomes.

https://doi.org/10.6061/clinics/2019/e1074 732 downloads

14.

Hypertonic saline and pentoxifylline enhance survival, reducing apoptosis and oxidative stress in a rat model of strangulated closed loop small bowel obstruction
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Scapini, Gustavo

; Rasslan, Roberto

; Cayuela, Natalie Chaves

; Goes, Miguel Angelo

; Koike, Marcia Kiyomi

; Utiyama, Edivaldo Massazo

; Souza Montero, Edna Frasson de

; Rasslan, Samir

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2019, Volume 74 elocation e787

Resumo: En | Texto: En | PDF: En

OBJECTIVES: Intestinal obstruction has a high mortality rate when therapeutic treatment is delayed. Resuscitation in intestinal obstruction requires a large volume of fluid, and fluid combinations have been studied. Therefore, we evaluated the effects of hypertonic saline solution (HS) with pentoxifylline (PTX) on apoptosis, oxidative stress and survival rate. METHODS: Wistar rats were subjected to intestinal obstruction and ischemia through a closed loop ligation of the terminal ileum and its vessels. After 24 hours, the necrotic bowel segment was resected, and the animals were randomized into four groups according to the following resuscitation strategies: Ringer's lactate solution (RL) (RL-32 ml/kg); RL+PTX (25 mg/kg); HS+PTX (HS, 7.5%, 4 ml/kg), and no resuscitation (IO-intestinal obstruction and ischemia). Euthanasia was performed 3 hours after resuscitation to obtain kidney and intestine samples. A malondialdehyde (MDA) assay was performed to evaluate oxidative stress, and histochemical analyses (terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling [TUNEL], Bcl-2 and Bax) were conducted to evaluate kidney apoptosis. Survival was analyzed with another series of animals that were observed for 15 days. RESULTS: PTX in combination with RL or HS reduced the MDA levels (nmol/mg of protein), as follows: kidney IO=0.42; RL=0.49; RL+PTX=0.31; HS+PTX=0.34 (p<0.05); intestine: IO=0.42; RL=0.48; RL+PTX=0.29; HS+PTX=0.26 (p<0.05). The number of labeled cells for TUNEL and Bax was lower in the HS+PTX group than in the other groups (p<0.05). The Bax/Bcl-2 ratio was lower in the HS+PTX group than in the other groups (p<0.05). The survival rate on the 15th day was higher in the HS+PTX group (77%) than in the RL+PTX group (11%). CONCLUSION: PTX in combination with HS enhanced survival and attenuated oxidative stress and apoptosis. However, when combined with RL, PTX did not reduce apoptosis or mortality.

https://doi.org/10.6061/clinics/2019/e787 1051 downloads

15.

Continuous peritoneal lavage with vacuum peritoneostomy: an experimental study
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Rodrigues, Adilson Costa

; Saad, Karen Ruggeri

; Saad, Paulo Fernandes

; Otsuki, Denise Aya

; Santos, Luana Carla dos

; Rasslan, Samir

; Montero, Edna Frasson de Souza

; Utiyama, Edivaldo M.

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2019, Volume 74 elocation e937

Resumo: En | Texto: En | PDF: En

OBJECTIVE: Despite advances in diffuse peritonitis treatment protocols, some cases develop unfavorably. With the advent of vacuum therapy, the use of laparostomy to treat peritonitis has gained traction. Another treatment modality is continuous peritoneal lavage. However, maintaining this technique is difficult and has been associated with controversial results. We propose a new model of continuous peritoneal lavage that takes advantage of the features and benefits of vacuum laparostomy. METHOD: Pigs (Landrace and Large White) under general anesthesia were submitted to laparostomy through which a multiperforated tube was placed along each flank and exteriorized in the left and lower right quadrants. A vacuum dressing was applied, and intermittent negative pressure was maintained. Peritoneal dialysis solution (PDS) was then infused through the tubes for 36 hours. The stability of peritoneostomy with intermittent infusion of fluids, the system resistance to obstruction and leakage, water balance, hemodynamic and biochemical parameters were evaluated. Fluid disposition in the abdominal cavity was analyzed through CT. RESULTS: Even when negative pressure was not applied, the dressing maintained the integrity of the system, and there were no leaks or blockage of the catheters during the procedure. The aspirated volume by vacuum laparostomy was similar to the infused volume (9073.5±1496.35 mL versus 10165±235.73 mL, p=0.25), and there were no major changes in hemodynamic or biochemical analysis. According to CT images, 60 ml/kg PDS was sufficient to occupy all intra-abdominal spaces. CONCLUSION: Continuous peritoneal lavage with negative pressure proved to be technically possible and may be an option in the treatment of diffuse peritonitis.

https://doi.org/10.6061/clinics/2019/e937 607 downloads

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