Association between the Alvarado score and surgical and histopathological findings in acute appendicitis. / Associação entre o escore de Alvarado, achados cirúrgicos e aspecto histopatológico da apendicite aguda.

OBJECTIVE: to compare the results of the Alvarado score with the surgical findings and the results of the histopathological examination of the appendix of patients operated on for acute appendicitis. METHODS: we conducted an observational study with a cross-sectional design of 101 patients aged 14 years and over undergoing emergency appendectomy. The evaluation comprised the Alvarado score, gender, age, ethnicity and time of evolution. We obtained data regarding the surgical aspect of the appendix, postoperative complications and the result of the histopathological examination. The pre-established confidence interval was 95%. We calculated sensitivity, specificity, positive and negative predictive values of the score, and performed an analysis through the ROC curve. RESULTS: we found a statistically significant (p=0.002) association between the Alvarado score and the diagnostic confirmation using a cutoff score of six or greater, with a sensitivity of 72% and a specificity of 87.5%. A score greater than or equal to six showed a greater tendency to present more advanced stages of acute appendicitis in both surgical and histopathological findings when compared with a score lower than six. Males presented greater chances of complications when compared with females (p=0.003). CONCLUSION: the Alvarado score proved to be a good method for diagnostic screening in acute appendicitis, since scores greater than or equal to six are associated with a higher probability of diagnostic confirmation and more advanced stages of the acute disease.

OBJETIVO: comparar o resultado do escore de Alvarado com os achados cirúrgicos e com os resultados do exame histopatológico do apêndice de pacientes operados por apendicite aguda. MÉTODOS: estudo observacional com delineamento transversal de 101 pacientes com 14 anos de idade ou mais, submetidos à apendicectomia de urgência. A avaliação continha o escore de Alvarado, pontuação no escore, sexo, idade, etnia dos pacientes e tempo de evolução. Foi obtido o aspecto cirúrgico do apêndice, dados a respeito das complicações pós-operatórias e o resultado do exame histopatológico. O intervalo de confiança pré-estabelecido foi de 95%. Foram calculadas sensibilidade, especificidade, valor preditivo positivo e negativo do escore, e realizada uma análise através da curva ROC. RESULTADOS: a associação entre o escore de Alvarado e a confirmação diagnóstica utilizando como ponto de corte uma pontuação maior ou igual a seis encontrou-se significância estatística (P=0,002), com sensibilidade de 72% e especificidade de 87,5%. A pontuação maior ou igual a seis mostrou maior tendência a apresentar fases mais avançadas da apendicite aguda tanto no aspecto cirúrgico quanto histopatológico, quando comparado a uma pontuação menor que seis. O sexo masculino apresentou maiores chances de complicações quando comparado ao sexo feminino (P=0,003). CONCLUSÃO: o escore de Alvarado se mostrou um bom método para triagem diagnóstica na apendicite aguda, já que pontuações maiores ou iguais a seis estão associadas a uma probabilidade maior de confirmação diagnóstica e de quadros mais avançados da doença aguda.

Associação entre o escore de Alvarado, achados cirúrgicos e aspecto histopatológico da apendicite aguda / Association between the Alvarado score and surgical and histopathological findings in acute appendicitis

RESUMO Objetivo: comparar o resultado do escore de Alvarado com os achados cirúrgicos e com os resultados do exame histopatológico do apêndice de pacientes operados por apendicite aguda. Métodos: estudo observacional com delineamento transversal de 101 pacientes com 14 anos de idade ou mais, submetidos à apendicectomia de urgência. A avaliação continha o escore de Alvarado, pontuação no escore, sexo, idade, etnia dos pacientes e tempo de evolução. Foi obtido o aspecto cirúrgico do apêndice, dados a respeito das complicações pós-operatórias e o resultado do exame histopatológico. O intervalo de confiança pré-estabelecido foi de 95%. Foram calculadas sensibilidade, especificidade, valor preditivo positivo e negativo do escore, e realizada uma análise através da curva ROC. Resultados: a associação entre o escore de Alvarado e a confirmação diagnóstica utilizando como ponto de corte uma pontuação maior ou igual a seis encontrou-se significância estatística (P=0,002), com sensibilidade de 72% e especificidade de 87,5%. A pontuação maior ou igual a seis mostrou maior tendência a apresentar fases mais avançadas da apendicite aguda tanto no aspecto cirúrgico quanto histopatológico, quando comparado a uma pontuação menor que seis. O sexo masculino apresentou maiores chances de complicações quando comparado ao sexo feminino (P=0,003). Conclusão: o escore de Alvarado se mostrou um bom método para triagem diagnóstica na apendicite aguda, já que pontuações maiores ou iguais a seis estão associadas a uma probabilidade maior de confirmação diagnóstica e de quadros mais avançados da doença aguda.

ABSTRACT Objective: to compare the results of the Alvarado score with the surgical findings and the results of the histopathological examination of the appendix of patients operated on for acute appendicitis. Methods: we conducted an observational study with a cross-sectional design of 101 patients aged 14 years and over undergoing emergency appendectomy. The evaluation comprised the Alvarado score, gender, age, ethnicity and time of evolution. We obtained data regarding the surgical aspect of the appendix, postoperative complications and the result of the histopathological examination. The pre-established confidence interval was 95%. We calculated sensitivity, specificity, positive and negative predictive values of the score, and performed an analysis through the ROC curve. Results: we found a statistically significant (p=0.002) association between the Alvarado score and the diagnostic confirmation using a cutoff score of six or greater, with a sensitivity of 72% and a specificity of 87.5%. A score greater than or equal to six showed a greater tendency to present more advanced stages of acute appendicitis in both surgical and histopathological findings when compared with a score lower than six. Males presented greater chances of complications when compared with females (p=0.003). Conclusion: the Alvarado score proved to be a good method for diagnostic screening in acute appendicitis, since scores greater than or equal to six are associated with a higher probability of diagnostic confirmation and more advanced stages of the acute disease.

COMPLICATIONS REQUIRING HOSPITAL MANAGEMENT AFTER BARIATRIC SURGERY.

BACKGROUND: The actual gold standard technique for obesity treatment is the Roux-en-Y gastric bypass. However, complications may occur and the surgeon must be prepared for them. AIM: To evaluate retrospectively the complications occurrence and associated factors in patients who underwent bariatric surgery. METHODS: In this study, 469 medical charts were considered, from patients and from data collected during outpatient consultations. The variables considered were gender, age, height, pre-operatory BMI, pre-operatory weight, pre-operatory comorbidities, time of hospital stay, postoperative complications that demanded re-admission to the hospital and the time elapsed between the procedure and the complication. The patients' follow up was, at least, one year. RESULTS: The incidence of postoperative complications that demanded a hospital care was 24,09%. The main comorbidity presented in this sample was hepatic steatosis. The comorbidity that was associated with the postoperative period was type 2 diabetes. There was a tendency for the female gender be related to the complications. The cholecystectomy was the most frequent complication. Complications occurred during the first year in 57,35%. CONCLUSION: The most frequent complication was the need to perform a cholecystectomy, where the most frequent comorbidity was hepatic steatosis. Over half the complications occurred during the first year postoperatively. Type 2 diabetes was associated with the occurrence of postoperative complications; women had the highest incidence; body mass index was not associated with the occurrence of complications.

GLYCEMIC BEHAVIOR IN 48 HOURS POSTOPERATIVE PERIOD OF PATIENTS WITH TYPE 2 DIABETES MELLITUS AND NON DIABETIC SUBMITTED TO BARIATRIC SURGERY.

UNLABELLED: Although there is no indication for surgery taking only into account the glycemic condition, results have shown that benefits can be obtained in glycemic control with bariatric surgery. AIM: To compare the glycemic behavior among type 2 diabetic and non-diabetic patients within 48 h after bariatric surgery, and clarify whether there is a reduction in blood glucose level in obese patients with diabetes before the loss of weight excess. METHODS: Descriptive epidemiological study with prospective cohort design with 31 obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy. The patients were controlled with hemoglucotests in different periods of time: preoperative, postoperative and each 6 h after surgery for 48 h. RESULTS: Average ambulatory blood glucose in diabetics was 120.7±2.9 mg/dl vs 91.8±13.9 mg/dl in the nondiabetic. After 48 h there was decrease in diabetics to 100.0±17.0 mg/dl (p=0.003), while the non-diabetic group did not change significantly (102.7±25.4 mg/dl; p=0.097). There were no differences between the surgical techniques. There were no death. CONCLUSIONS: Diabetic patients significantly reduced blood glucose after surgery regardless of the use of exogenous insulin or oral hypoglycemic agents.

Nutritional repercussions in patients submitted to bariatric surgery.

BACKGROUND: Few studies evaluated the association between nutritional disorders, quality of life and weight loss in patients undergoing bariatric surgery. AIM: To identify nutritional changes in patients undergoing bariatric surgery and correlate them with weight loss, control of comorbidities and quality of life. METHOD: A prospective cohort, analytical and descriptive study involving 59 patients undergoing bariatric surgery was done. Data were collected preoperatively at three and six months postoperatively, evaluating nutritional aspects and outcomes using BAROS questionnaire. The data had a confidence interval of 95%. RESULTS: The majority of patients was composed of women, 47 (79.7%), with 55.9% of the series with BMI between 40 to 49.9 kg/m(²). In the sixth month after surgery scores of quality of life were significantly higher than preoperatively (p<0.05) and 27 (67.5 %) patients had comorbidities resolved, 48 (81.3 %) presented BAROS scores of very good or excellent. After three and six months of surgery 16 and 23 presented some nutritional disorder, respectively. There was no relationship between the loss of excess weight and quality of life among patients with or without nutritional disorders. CONCLUSION: Nutritional disorders are uncommon in the early postoperative period and, when present, have little or no influence on quality of life and loss of excess weight.