The Safety and Cost Analysis of Outpatient Laparoendoscopy in the Treatment of Cholecystocholedocholithiasis: A Retrospective Study.

INTRODUCTION: The advantages of single-stage treatment of cholecystocholedocholithiasis are well established, but the conditions for carrying out treatment on an outpatient basis require a review of concepts and practices of medical corporations. OBJECTIVE: To evaluate the practice of treating cholecystocholedocholithiasis by laparoendoscopy on an outpatient basis with cost analysis. METHOD: A retrospective study was conducted on patients with cholecystocholedocholithiasis treated by combined laparoscopic cholecystectomy and endoscopic choledocholithotomy from January 2015 to January 2019. After collecting data from physical and digital medical records, the patients were divided into two groups-AR (n = 42)-ambulatory regimen and HR (n = 28)-hospitalization regimen-which were compared in terms of demographic, clinical and treatment variables and their results, as well as in terms of costs. RESULTS: The mean age of the AR group was lower than that of the HR group and the physical status of the AR patients was better when assessed according to the American Society of Anesthesiologists (ASA) (p = 0.01). There was no difference between groups regarding the risk of choledocholithiasis (p = 0.99). For the AR group, the length of stay was shorter: 11.29 h × 65.21 h (p = 0.02), as was the incidence of postoperative complications assessed by applying the Clavien-Dindo classification: 3 (7.1%) × 11 (39.2%) (p < 0.01). The total mean costs were higher for the HR group (USD 2489.93) than the AR group (USD 1650.98) (p = 0.02). CONCLUSION: Outpatient treatment of cholecystocholedocholithiasis by laparoendoscopy is safe and viable for most cases, has a lower cost and can support the reorientation of training and practice of hepatobiliary surgeons.

La empatía, la comunicación efectiva y la asertividad en la práctica médica actual / Empathy, effective communication and assertiveness in current medical practice

Resumen La empatía, la comunicación efectiva y la asertividad en la práctica médica actual representan habilidades y herramientas necesarias y vigentes en un mundo de grandes avances y realidades tecnológicas que no superan, en nuestra perspectiva, lo indispensable para mantener y fortalecer la relación del profesional de la salud con el paciente, específicamente la relación médico-paciente. Es conveniente identificar y reconocer el hecho de que estas relaciones interpersonales deben ser modificadas mediante el reconocimiento de su bidireccionalidad y deben centrarse en un carácter educativo, de retroalimentación y atención mutua, con una mejora continua de la regla de las "15 C": comunicación, cercanía, comprensión, compasión, confianza, capacidad, consistencia, certificación, creatividad, cooperación/coordinación, compromiso bidireccional y conexión, con las resultantes calidad y calidez.

Abstract Empathy, effective communication and assertiveness in current medical practice represent skills and tools necessary and current, in a world of great advances and technological realities that do not surpass, in our perspective, the indispensable use of such tools to maintain and strengthen the relationship of the health professional with the patient and specifically of the doctor-patient relationship. It is convenient to identify and recognize the fact that these interpersonal relationships must be modified by recognizing their bidirectionality and that they should focus on an educational, feedback and mutual attention, with a continuous improvement of the "15 C" rule: communication, closeness, understanding, compassion, confidence, capacity, consistency, certification, creativity, cooperation/coordination and bidirectional commitment and connection, with the resulting quality and warmth.

Outbreaks of Brachiaria ruziziensis and Brachiaria brizantha intoxications in Brazilian experienced cattle.

Brachiaria species are some of the most used forage species for raising Brazilian cattle because of their great nutritional value and adaptability to the tropical climate. However, cases of animal intoxication have been described. Animal species, age, genetic resistance, and previous adaptation to the forage can influence the susceptibility to intoxication. Cattle (young or adults), other adult ruminants and animals adapted to consumption (experienced flocks) are considered more resistant. The main clinical presentation is that of hepatogenous photosensitization. Brachiaria brizantha and Brachiaria ruziziensis are considered less toxic. The aim of this study is to describe three outbreaks of intoxication by B. brizantha and B. ruziziensis in experienced cattle, as well as to compare the concentrations of protodioscin in paddocks with and without clinical cases. It was observed that the two forage species are toxic to all age groups of cattle adapted to their consumption, and the concentrations of protodioscin present in the plant cannot be used as the only criterion for determining the occurrence of intoxication.

The role of circulating miRNAs and CA19-9 in pancreatic cancer diagnosis.

Diagnosis and treatment of pancreatic ductal adenocarcinoma (PA) remains a challenge in clinical practice. The aim of this study was to assess the role of microRNAs (miRNAs-21, -23a, -100, -107, -181c, -210) in plasma and tissue as possible biomarkers in the diagnosis of PA. Samples of plasma (PAp-n = 13), pancreatic tumors (PAt-n = 18), peritumoral regions (PPT-n = 9) were collected from patients during the surgical procedure. The control group consisted of samples from patients submitted to pancreatic surgery for trauma or cadaveric organs (PC-n = 7) and healthy volunteers donated blood (PCp-n = 6). The expression profile of microRNAs was measured in all groups using RT-PCR, serum CA19-9 levels were determined in PA and PC. In tissue samples, there was a difference in the expression of miRNAs-21, -210 (p < 0.05) across the PAt, PC and PPT groups. The PAp showed overexpression of miRNAs-181c, -210 (p < 0.05) when compared to PCp. The combination of miRNAs-21, -210 tissue expression and serum CA19-9 showed 100% accuracy in the diagnosis of PA, as well as miR-181c expression in the plasma (PApxPCp). The expression of microRNAs in plasma proved to be a promising tool for a noninvasive detection test for PA, as well as further studies will evaluate the utility of microRNAs expression as biomarkers for prognostic and response to therapy in PA.

Clinical outcomes and costs of the use of fibrin sealant in pancreaticojejunal anastomosis after pancreaticoduodenectomy: a retrospective analysis study.

OBJECTIVES: The benefits of using a fibrin sealant to reinforce the pancreaticojejunal anastomosis are still contentious, a fact that justifies the study of its effects on clinical outcomes and costs of pancreaticoduodenectomy. METHODS: Study of 62 consecutive patients submitted to pancreaticoduodenectomy, divided into two groups of 31 patients each: GWS = group with sealant and GWOS = group without sealant that were compared according to demographic, clinical, laboratory aspects, the incidence of postoperative pancreatic fistula (POPF), according to the definition of the International Study Group on Pancreatic Fistula, updated in 2016, and its postoperative complications categorized according to the Clavien classification, as well as hospital costs evaluated by the absorption costing method (with the exception of those related to medications). RESULTS: The groups were homogeneous and there were no significant differences in the postoperative clinical course or in the indicators of hospital care between them. Hard texture of pancreatic tissue was the only protective factor against the development of POPF (RR = 0.29 (95%CI:0,12-0,68); p = 0.005). Moreover, hospital costs were higher in GWS than in GWOS (p < 0.0001). CONCLUSIONS: The use of fibrin sealant to reinforce pancreaticojejunal anastomosis did not improve the clinical and healthcare outcomes and, in addition, increased hospital costs.

IS THE NEW PROCORE 20G DOUBLE FORWARD-BEVEL NEEDLE CAPABLE TO OBTAIN BETTER HISTOLOGICAL SAMPLES BY ENDOSCOPIC ULTRASOUND FOR DIAGNOSING SOLID PANCREATIC LESIONS?

BACKGROUND: Fine needle biopsy (FNB) histological samples by endoscopic ultrasound. It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. AIM: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. METHODS: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. RESULTS: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. CONCLUSIONS: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.

Protodioscin levels in Brachiaria spp. in a sheep production system and a brief review of the literature of Brachiaria spp. poisoning in ruminants

ABSTRACT: Plants of the genus Brachiaria, used in several countries as forage, are poisonous to some livestock species. Their toxic principle is protodioscin, and the main form of clinical presentation of the toxicosis is hepatogenous photosensitization. Here we compare protodioscin levels in B. decumbens and B. brizantha and review the literature on the concentrations and methodologies of collection and analysis of the toxic principle in Brachiaria spp. and the risk of contamination of pastures by more toxic species that may facilitate poisoning by plants of this genus in sheep. The experiment was conducted in pastures originally formed by B. brizantha, with many B. decumbens invasion points. The occurrence of cases of poisoning by Brachiaria spp. was the criterion for confirming pasture toxicity. The forage samples were collected at ten random points every 28 days through manual grazing simulation. The samples were analyzed for protodioscin by high-performance liquid chromatography (HPLC) with light scattering by evaporation (ELSD) after being dried and crushed. In the flock of 69 sheep, five poisoning cases occurred, three sheep died, and two recovered. The protodioscin levels found in the evaluated pastures ranged from 0.70 to 0.45%; higher levels appeared in B. decumbens (7.09%) compared to 1.04% in B. brizantha. We suggest that Brachiaria spp. should be avoided in pastures where sheep are grazing.

RESUMO: Plantas do gênero Brachiaria, utilizadas em vários países como forragem, são tóxicas para várias espécies pecuárias. Seu princípio tóxico é a protodioscina, e a principal forma de apresentação clínica da toxicose é a fotossensibilização hepatógena. Este estudo teve como objetivo comparar os níveis de protodioscina em B. decumbens e B. brizantha e revisar a literatura sobre as concentrações e metodologias de coleta e análise do princípio tóxico em Brachiaria spp. e o risco de contaminação das pastagens por espécies mais tóxicas que podem facilitar a intoxicação por plantas desse gênero em ovinos. O experimento foi conduzido em pastagens originalmente formadas por B. brizantha, com diversos pontos de invasão por B. decumbens. Ocorrência de casos de intoxicação por Brachiaria spp. foi o critério para confirmação da toxicidade da pastagem. As amostras de forragem foram coletadas a cada 28 dias em dez pontos aleatórios por meio de simulação de pastejo manual. As amostras foram analisadas para protodioscina por cromatografia líquida de alta eficiência (HPLC) com dispersão de luz por evaporação (ELSD) após serem secadas e trituradas. No rebanho de 69 ovelhas, cinco desenvolveram a intoxicação, três morreram e duas se recuperaram. Os níveis de protodioscina encontrados nas pastagens avaliadas variaram de 0,70 a 0,45%; níveis mais elevados apareceram em B. decumbens (7,09%) em comparação com 1,04% em B. brizantha. Sugerimos que Brachiaria spp. deve ser evitada no pasto de ovelhas em pastejo.

Protodioscin levels in Brachiaria spp. in a sheep production system and a brief review of the literature of Brachiaria spp. poisoning in ruminants / Níveis de protodioscina em Brachiaria spp. em um sistema de produção de ovinos e uma breve revisão da literatura da intoxicação por Brachiaria spp. em ruminantes

Plants of the genus Brachiaria, used in several countries as forage, are poisonous to some livestock species. Their toxic principle is protodioscin, and the main form of clinical presentation of the toxicosis is hepatogenous photosensitization. Here we compare protodioscin levels in B. decumbens and B. brizantha and review the literature on the concentrations and methodologies of collection and analysis of the toxic principle in Brachiaria spp. and the risk of contamination of pastures by more toxic species that may facilitate poisoning by plants of this genus in sheep. The experiment was conducted in pastures originally formed by B. brizantha, with many B. decumbens invasion points. The occurrence of cases of poisoning by Brachiaria spp. was the criterion for confirming pasture toxicity. The forage samples were collected at ten random points every 28 days through manual grazing simulation. The samples were analyzed for protodioscin by high-performance liquid chromatography (HPLC) with light scattering by evaporation (ELSD) after being dried and crushed. In the flock of 69 sheep, five poisoning cases occurred, three sheep died, and two recovered. The protodioscin levels found in the evaluated pastures ranged from 0.70 to 0.45%; higher levels appeared in B. decumbens (7.09%) compared to 1.04% in B. brizantha. We suggest that Brachiaria spp. should be avoided in pastures where sheep are grazing.(AU)

Plantas do gênero Brachiaria, utilizadas em vários países como forragem, são tóxicas para várias espécies pecuárias. Seu princípio tóxico é a protodioscina, e a principal forma de apresentação clínica da toxicose é a fotossensibilização hepatógena. Este estudo teve como objetivo comparar os níveis de protodioscina em B. decumbens e B. brizantha e revisar a literatura sobre as concentrações e metodologias de coleta e análise do princípio tóxico em Brachiaria spp. e o risco de contaminação das pastagens por espécies mais tóxicas que podem facilitar a intoxicação por plantas desse gênero em ovinos. O experimento foi conduzido em pastagens originalmente formadas por B. brizantha, com diversos pontos de invasão por B. decumbens. Ocorrência de casos de intoxicação por Brachiaria spp. foi o critério para confirmação da toxicidade da pastagem. As amostras de forragem foram coletadas a cada 28 dias em dez pontos aleatórios por meio de simulação de pastejo manual. As amostras foram analisadas para protodioscina por cromatografia líquida de alta eficiência (HPLC) com dispersão de luz por evaporação (ELSD) após serem secadas e trituradas. No rebanho de 69 ovelhas, cinco desenvolveram a intoxicação, três morreram e duas se recuperaram. Os níveis de protodioscina encontrados nas pastagens avaliadas variaram de 0,70 a 0,45%; níveis mais elevados apareceram em B. decumbens (7,09%) em comparação com 1,04% em B. brizantha. Sugerimos que Brachiaria spp. deve ser evitada no pasto de ovelhas em pastejo.(AU)

Is the new procore 20g double forward-bevel needle capable to obtain better histological samples by endoscopic ultrasound for diagnosing solid pancreatic lesions? / A nova agulha procore 20g com bisel frontal duplo é capaz de obter melhores amostras histológicas por ecoendoscopia no diagnóstico de lesões sólidas pancreáticas?

ABSTRACT Background: It is important to obtain representative histological samples of solid biliopancreatic lesions without a clear indication for resection. The role of new needles in such task is yet to be determined. Aim: To compare performance assessment between 20G double fine needle biopsy (FNB) and conventional 22G fine needle aspiration (FNA) needles for endoscopic ultrasound (EUS)-guided biopsy. Methods: This prospective study examined 20 patients who underwent the random puncture of solid pancreatic lesions with both needles and the analysis of tissue samples by a single pathologist. Results: The ProCore 20G FNB needle provided more adequate tissue samples (16 vs. 9, p=0.039) with better cellularity quantitative scores (11 vs. 5, p=0.002) and larger diameter of the histological sample (1.51±1.3 mm vs. 0.94±0.55 mm, p=0.032) than the 22G needle. The technical success, puncture difficulty, and sample bleeding were similar between groups. The sensitivity, specificity, and diagnostic accuracy were 88.9%, 100%, and 90% and 77.8%, 100%, and 78.9% for the 20G and 22G needles, respectively. Conclusions: The samples obtained with the ProCore 20G FNB showed better histological parameters; although there was no difference in the diagnostic performance between the two needles, these findings may improve pathologist performance.

RESUMO Racional: As lesões sólidas pancreáticas não ressecáveis cirurgicamente demandam boa amostragem tecidual para definição histológica e condução oncológica . O papel das novas agulhas de ecopunção no aprimoramento diagnóstico ainda necessita elucidação. Objetivo: Comparar as biópsias guiadas por ecoendoscoopia com a nova agulha 20G de bisel frontal duplo (FNB) com a agulha de aspiração fina 22G convencional. Métodos: Este estudo prospectivo avaliou 20 pacientes submetidos à punção de lesões pancreáticas sólidas com ambas agulhas e envolveu análise de amostras teciduais por um único patologista. Resultados: A agulha FNB 20G forneceu amostras de tecido mais adequadas (16 vs. 9, p=0,039) com melhores escores quantitativos de celularidade (11 vs. 5, p=0,002) e maior diâmetro máximo da amostra histológica (1,51±1,3 mm vs. 0,94±0,55 mm, p=0,032) que a agulha 22G. O sucesso técnico, dificuldade de punção e sangramento da amostra foram semelhantes entre os grupos. A sensibilidade, especificidade e acurácia diagnóstica foram 88,9%, 100% e 90% e 77,8%, 100% e 78,9% para as agulhas 20G e 22G, respectivamente. Conclusão: As amostras obtidas com a FNB 20G apresentaram melhores parâmetros histológicos, embora não tenha havido diferença no desempenho diagnóstico entre as duas agulhas.

Bovine rabies: economic loss and its mitigation through antirabies vaccination / Raiva em bovinos: perdas econômicas e sua mitigação através da vacinação antirrábica

Rabies is among the most common neurological disease in cattle in Brazil, causing significant economic losses. Data on the economic impact of rabies in livestock are available in several countries. However, in Brazil, these data focus mainly on the public health point o view, emphasizing the costs related to the prevention of rabies in humans, in dogs, or wildlife. Specific studies carried out in different regions of Brazil indicate critical economic losses caused by rabies in cattle in this country. However, the studies on the losses caused by the disease in cattle lack a detailed analysis of the affected rural properties based on data from official disease control agencies. The objective of this work was to evaluate the economic impact of bovine rabies, and its mitigation through antirabies vaccination in rural properties in Mato Grosso do Sul, Midwestern Brazil.(AU)

A raiva é uma das doenças neurológicas mais comuns em bovinos no Brasil, causando perdas econômicas significativas. Dados sobre o impacto econômico da raiva em bovinos de vários países estão disponíveis. No entanto, no Brasil, esses dados enfocam principalmente o ponto de vista de saúde pública, enfatizando os custos relacionados à prevenção da raiva em humanos, em cães ou animais silvestres. Estudos pontuais realizados em diferentes regiões do Brasil indicam perdas econômicas importantes causadas pela raiva em bovinos no país. No entanto, os estudos sobre as perdas causadas pela doença em bovinos carecem de uma análise detalhada das propriedades rurais afetadas com base em dados das agências oficiais de controle de doenças. O objetivo deste trabalho foi avaliar o impacto econômico da raiva bovina e sua mitigação através da vacinação antirrábica em propriedades rurais de Mato Grosso do Sul, no Centro-Oeste do Brasil.(AU)

Economic losses due to Vernonia rubricaulis poisoning in cattle / Perdas econômicas causadas pela intoxicação por Vernonia rubricaulis em bovinos

Vernonia rubricaulis is a hepatotoxic plant found in the Pantanal biome. Under natural conditions, it is responsible for highly fatal poisonings in cattle. From January 1999 to December 2016, 33 outbreaks of V. rubricaulis poisoning were recorded, resulting in 1509 bovine deaths, of which 719 (47.6%) were adult females, 413 (27.4%) were adult males, 244 (16.2%) adult cattle with no information about sex and 133 (8.8%) calves. The coefficients of morbidity, mortality and lethality were respectively 2.79%, 2.77% and 99.24%. Most outbreaks occurred in properties containing up to 1,000 cattle, where the most significant economic impacts were also observed. Among the total recorded deaths, the total direct monetary loss was estimated at US$764,893.33, which represents an average of 3.05% of the total assets (US$25,090,683.51) of the herds involved in the outbreaks. The plant can cause more severe damage to properties with less than 500 cattle, and can reach 50% of the total value of the herd. In comparison to other methods, the methodology used in this study has an economic impact consistent with reality, not overestimating the losses. Toxic plants, such as V. rubricaulis, can cause significant economic losses in the extensive systemic livestock, and it is important decision-making and prophylactic management to avoid the occurrence of poisoning in the herds.(AU)

Vernonia rubricaulis é uma planta hepatotóxica encontrada no bioma Pantanal. Em condições naturais, é responsável por intoxicações altamente fatais em bovinos. De janeiro de 1999 a dezembro de 2016, foram registrados 33 surtos de intoxicação por V. rubricaulis em bovinos que resultaram em 1509 mortes, sendo 719 (47,6%) fêmeas adultas, 413 (27,4%) machos adultos, 244 (16,2%) bovinos adultos sem informação sobre o sexo e 133 (8,8%) bezerros. Os coeficientes de morbidade, mortalidade e letalidade foram respectivamente de 2,79%, 2,77% e 99,24%. A maioria dos surtos ocorreu em propriedades contendo até mil bovinos, onde também foram constatados os impactos econômicos mais significativos. Do total das mortes registradas, o prejuízo monetário direto total foi calculado em US$764.893,33, o que representa em média 3,05% do total do patrimônio (US$25.090.683,51) dos rebanhos envolvidos nos surtos. A planta pode causar prejuízos mais severos em propriedades com menos de 500 bovinos, podendo chegar a 50% do total do valor do rebanho. Em comparação aos outros métodos, a metodologia utilizada neste estudo afere um impacto econômico condizente com a realidade, não superestimando os prejuízos. Plantas tóxicas, como a V. rubricaulis, podem causar prejuízos econômicos significativos na pecuária extensiva, sendo importantes tomadas de decisões e manejos profiláticos para evitar a ocorrência de intoxicação nos rebanhos.(AU)

Economic impact of an outbreak of botulism in a cattle feedlot / Impacto econômico de um surto de botulismo em confinamento de bovinos

Botulism is a febrile disease, fatal in most cases, which affects the muscles of locomotion, chewing, and swallowing, as well as the diaphragm and intercostal muscles, causing flaccid paralysis and respiratory arrest. In bovines, the etiology is due to the ingestion of neurotoxins types C and D formed by the bacterium Clostridium botulinum in an animal or vegetal substance, during decomposition. Vaccination is one of the most effective prophylactic means to prevent this disease. In this study, an outbreak of botulism was evaluated in a feedlot with 6,300 finishing cattle, wherein 25 died as a consequence of contracting this disease. The economic losses resulting from the deaths were analyzed, and economic analysis was conducted, involving the estimated cost of vaccination for the whole herd under risk, with the objective of evaluating whether this prophylactic practice is a viable action plan. The financial loss due to the deaths resulting from botulism in the case studied was found to be R$55,560.00, equivalent to 0.39% of the total monetary value of the herd. The cost of immunizing the entire herd under risk was 14.06% (for toxins exclusive to toxins C and D) and 22.22% (for polyvalent vaccines against clostridiosis) of the financial loss incurred as a consequence of the recorded deaths. It was concluded that botulism is a disease that can cause a significant economic impact on intensive livestock production systems, and that vaccination is an economically viable prophylactic action if performed with adequate sanitary planning.(AU)

O botulismo é uma doença afebril, fatal na maioria dos casos, que afeta os músculos da locomoção, mastigação, deglutição e também o diafragma e os músculos intercostais, causando paralisia flácida e parada respiratória. Nos bovinos a etiologia é devido à ingestão de neurotoxinas tipos C e D previamente formadas pela bactéria Clostridium botulinum em matéria animal ou vegetal em decomposição. A vacinação é um dos meios profiláticos mais eficazes para prevenir esta doença. Neste trabalho, estudou-se um surto de botulismo em um confinamento com 6300 bovinos em terminação, no qual 25 morreram devido a esta doença. Foram analisadas as perdas econômicas em consequência das mortes, e por meio do percentual do prejuízo contabilizado, foi realizada uma análise econômica referente ao custo estimado da vacinação para todo do rebanho sob-risco com o objetivo de avaliar se esta prática profilática é um plano de ação viável. Como resultado, o prejuízo financeiro devido às mortes resultantes do botulismo no caso estudado foi de R$ 55.560,00 o equivalente a 0,39% do valor monetário total do rebanho. O custo da vacinação para imunizar todo o rebanho sob-risco foi equivalente a 14,06% (para vacinas exclusivas para toxinas C e D) e 22,22% (para vacinas polivalentes contra clostridioses) relativo ao prejuízo financeiro em consequência dos óbitos registrados. Concluiu-se que o botulismo é uma doença que pode provocar impacto econômico significativo em sistemas de corte intensivos em bovinos, e que, a vacinação é um meio profilático economicamente viável se for realizada por meio de um planejamento sanitário adequado.(AU)

[The radiologist physician in major trauma evaluation]. / El médico radiólogo en la evaluación del trauma contuso toracoabdominopélvico.

BACKGROUND: Trauma is the most common cause of death in young adults. A multidisciplinary trauma team consists of at least a surgical team, an anesthesiology team, radiologic team, and an emergency department team. OBJECTIVE: Recognize the integration of multidisciplinary medical team in managing the trauma patient and which must include the radiologist physician responsible for the institutional approach to the systematization of the trauma patient regarding any radiological and imaging study with emphasis on the FAST (del inglés, Focused Assessment with Sonography in Trauma)/USTA, Whole body computed tomography. METHODS: Ultrasound is a cross-sectional method available for use in patients with major trauma. Whole-body multidetector computed tomography became the imaging modality of choice in the late 1990s. RESULTS: In patients with major trauma, examination FAST often is the initial imaging examination, extended to extraabdominal regions. Patients who have multitrauma from blunt mechanisms often require multiple diagnostic examinations, including Computed Tomography imaging of the torso as well as abdominopelvic Computed Tomography angiography. CONCLUSIONS: Multiphasic Whole-body trauma imaging is feasible, helps detect clinically relevant vascular injuries, and results in diagnostic image quality in the majority of patients. Computed Tomography has gained importance in the early diagnostic phase of trauma care in the emergency room. With a single continuous acquisition, whole-body computed tomography angiography is able to demonstrate all potentially injured organs, as well as vascular and bone structures, from the circle of Willis to the symphysis pubis.

Impacto da implantação de um novo modelo de gestão embasado em indicadores no bloco cirúrgico de um hospital universitário terciário / Impact of the implementation of a new model management indicators inthe surgical pack of a tertiary teaching hospital

O centro cirúrgico, por suas particularidades e características, constitui uma das unidades mais complexas do ambiente hospitalar. Assim, percebe-se que o bom desempenho de um centro cirúrgico está diretamente relacionado com a qualidade de seus próprios processos e com os processos dos serviços que o apoiam. Em Julho de 2012, com a portaria 194 – HCRP (5), é estabelecido as Diretrizes Gerais de Funcionamento do Bloco Cirúrgico do HC campus.O objetivo do presente estudo é avaliar o impacto do novo modelo gerencial do Bloco Cirúrgico do Campus implantado.Trata-se de séria histórica descritiva e retrospectiva com análise de alguns indicadores comparando anova gestão com a fase prévia.Nota-se melhora progressiva em alguns indicadores analisados, alcançando metas estipuladas pelo próprio Planejamento estratégico vigente.O presente estudo pode ilustrar o impacto de um modelo gerencial dentro do Centro Cirúrgico de um Hospital Escola Terciário de grande porte, mostrando os avanços alcançados e os pontos com oportunidades de melhoria...

The surgical center, by their features and characteristics, is one of the drives more complex hospitalenvironment. Thus, it is clear that the good performance of a surgical center is directly related to thequality of their own processes and with the processes of the services that support it. In July 2012, with ordinance 194 - HCRP, is established General guidelines for the Operation of Block Círurgico HC campus. The objective of this study is to evaluate the impact of the new management model of Surgical Block the HCRP-campus deployed. It would be historic descriptive and retrospective analysis of some indicators comparing the new management with the prior phase. Note progressive improvement in some indicators analyzed, reaching targets set by the strategic Planning current. The present study may serve to illustrate the impact of a management model with in the Surgical Center of a Hospital Tertiary School large, showing the progress made and the points with opportunities for improvement...

[The role of the computed tomography in the identification of the syndrome of pelvic congestion]. / El papel de la tomografía computada en la identificación del síndrome de congestión pélvica.

BACKGROUND: Pelvic congestion syndrome is a condition not yet fully understood, hence provokes controversy. It is cause of up to 40% of visits to the doctor; affecting women of reproductive age who experience non-specific symptoms such as characteristic pelvic pain with more than six months of evolution and difficult to treat dyspareunia in which even narcotics are insufficient for control. OBJECTIVE: To recognize the vascular anatomy of the pelvic cavity and identify the characteristics of pelvic congestion syndrome demonstrable by computed tomography. MATERIAL AND METHODS: A descriptive, observational, cross-sectional and retrospective study at Hospital Angeles del Pedregal, in the Department of Radiology and Imaging with patients who reported imaging studies with key findings to recognize the pelvic congestion syndrome. All women with incidental finding of abnormal dilation of the gonadal vein were included, allowing to suggest pelvic congestion syndrome as a possible diagnosis. RESULTS: There were 17 cases (0.9%) of patients with abdominopelvic pain syndrome who underwent multislice computed tomography to 3 mm, with extension from the lung bases to the pubic symphysis. Predominance of left gonadal vein is conditioned by the anatomical arrangement of the left gonadal vein. During the arterial phase opacification of the gonadal vein was identified in 11 patients (65%), a circumstance that correlates with retrograde venous flow valve incompetence. In computed tomography findings of pelvic congestion syndrome were also identified 12 patients (70%) with abdominopelvic pain syndrome. CONCLUSIONS: Pelvic congestion syndrome is a rare condition that radiologists do not consider because they don't know it and the clinical diagnoses give no clinical data to suggest this condition. But if one takes into account the literature, it refers to it as the origin of up to 40% of the visits to the gynecologist, and there may be more cases that will increase its prevalence.

[Assessment of neoplastic pancreatic focal injury by multidetector computed tomography]. / Evaluación de lesiones focales neoplásicas pancreáticas por tomografía computarizada multidetector.

INTRODUCTION: pancreatic focal neoplastic lesions (PFNL) should be characterized through image methods to differentiate from no neoplastic lesions, suggesting one or more probable diagnosis, and staging of malignant lesions, in order to help define the estrategy of medial or surgical management. The multidetector computed tomography (MDCT) offers multiple properties and advantages that enable adequate characterization of the PFNL. The objective of this study is to evaluate de usefulness of MDCT in characterizing PFNL. MATERIAL AND METHODS: a descriptive, retrospective caseseries study has been conducted. It consisted of reviewing MDCT studies in which PFNL were found, over a period of 4 years 11 months from January 2006 to November 2010. RESULTS: we obtained 54 cases of PFNL which were characterized by MDCT; 75.9% for a specific diagnosis, and were categorized as indeterminate 24.1%, considering more than one possible diagnosis. The most frequent PFNL type was pancreatic ductal adenocarcinoma in 51.9%. Pancreatic cystic neoplasms accounted for 16.7%. CONCLUSIONS: MDCT is useful for identifying and characterizing LFNP, this means the possibility of establishing one or more diagnostic possibilities and guide medical management.

Results achieved by emergency physicians in teaching basic cardiopulmonary resuscitation to secondary school students.

OBJECTIVE: We investigated the results obtained with a basic cardiopulmonary resuscitation (b-CPR) program (PROCES) specifically designed for secondary school students (14-16 years old) and taught by emergency physicians. METHODS: We used a multiple-choice test with 20 questions (10 on theory and 10 on skills) answered before and immediately after and 1 year after receiving the b-CPR course. Satisfactory learning was considered when at least 8 out of 10 skill questions were correctly answered. We investigated student variables associated with better immediate and deferred (1 year after) PROCES performance. We compared the results with those obtained using a more standardized program to teach b-CPR to police cadets. RESULTS: We enrolled 600 high school students. PROCES achieved significant improvement in overall, theory and skill marks immediately after the course (P<0.001), with a significant decay in all of them 1 year after the course (P<0.001). Satisfactory learning was achieved by 57% of school students immediately after PROCES and by 37% when assessed 1 year later. Students without pending study subjects (P=0.001) and those from private schools (P<0.01) achieved significantly better performance immediately after PROCES and only female students achieved greater performance 1 year after the course (P<0.05). With respect to police cadets instructed through a standardized course, immediate satisfactory learning of school students was lower (79 vs. 57%, respectively; P<0.001), whereas deferred satisfactory learning was higher (23 vs. 37%, respectively; P<0.05). CONCLUSION: Emergency physicians can satisfactorily instruct secondary school students in b-CPR using PROCES, and this specific program achieves a reasonable amount of satisfactory learning.

Gastroesophageal reflux disease: integrating the barium esophagram before and after antireflux surgery.

Gastroesophageal reflux disease (GERD) is a common medical problem in the United States. As a result, laparoscopic antireflux surgery is a common surgical procedure. At the authors' institution, the barium esophagram before and after antireflux surgery is a critical examination in patients with GERD. This article summarizes the authors' examination protocol and describes how the findings are integrated in the care of these patients.

Amyand's hernia: a case report of prospective ct diagnosis in the emergency department.

The diagnosis of Amyand's hernia, the development of acute appendicits within an inguinal hernia, is rarely made preoperatively and is often confused clinically with an incarcerated right inguinal hernia. The use of CT to prospectively diagnose Amyand's hernia and corresponding imaging findings are not well described in the literature. We report a case of Amyand's hernia, which was correctly diagnosed by CT in a female patient presented to the emergency department with right lower quadrant pain and clinical suspicion of a strangulated omentocele.

Tumor renal quístico multiocular: Nefroma quístico. Informe de un caso y revisión de la literatura / Multiocular cystic renal tumor: Cystic nephroma. A case report and review of the literature

Se trata de paciente preescolar masculino, sin antecedentes de importancia, que es referido por médico general a este centro hospitalario, al ser consultado por la madre al detectar ésta la presencia de masa en el flanco izquierdo del paciente. Por dicha razón es referido, realizándosele estudios de ultrasonografía, urograma excretor y tomografía computada de abdomen que demuestran la presencia de masa quística multilocular renal izquierda con remanente de parénquima renal funcional hacia el polo superior, mismo que es desplazado por la presencia de dicha masa. Se decide realizar cirugía (nefrectomía total) ante la sospecha de lesión tumoral maligna del tipo tumor de Wilms quístico, obteniéndose el informe histopatológico de nefroma quístico. Actualmente el paciente cursa asintomático.