RESUMO
BACKGROUND: Isolated perforations of hollow viscus (HV) represent less than 1% of injuries in blunt abdominal trauma (BAT). When they do present, they are generally due to high-impact mechanisms in the segments of the intestine that are fixed. The aim of this study is to determine the incidence of major HV injuries in BAT at the "Dr. Domingo Luciani" General Hospital (HDL), and address the literature gap regarding updated HV perforations following BAT, especially in low-income settings. METHODS: A retrospective review was conducted on the medical records of patients admitted to our trauma center with a diagnosis of complicated BAT with HV perforation over 14 years. RESULTS AND DISCUSSION: Seven hundred sixty-one patients were admitted under the diagnosis of BAT. Of them, 36.79% underwent emergency surgical resolution, and 6.04% had HV perforation as an operative finding. Almost half (44.44%) of these cases presented as a single isolated injury, while the remaining were associated with other intra-abdominal organ injuries. The most common lesions were Grade II-III jejunum and Grade I transverse colon, affecting an equal proportion of patients at 13.33%. In recent years, an increased incidence of HV injuries secondary to BAT has been observed. Despite this, in many cases, the diagnosis is delayed, so even in the presence of negative diagnostic studies, the surgical approach based on the trauma mechanism, hemodynamic status, and systematic reevaluation of the polytraumatized patient should prevail.
Assuntos
Traumatismos Abdominais , Perfuração Intestinal , Ferimentos não Penetrantes , Humanos , Centros de Traumatologia , Ferimentos não Penetrantes/epidemiologia , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/complicações , Traumatismos Abdominais/epidemiologia , Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/complicações , Jejuno , Perfuração Intestinal/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Vesicourethral anastomosis stenosis (VUAS) refers to the diameter narrowing of a vesicourethral anastomosis (VUA). It is a known complication after radical prostatectomy that nowadays presents in less than 1% of these cases. When the lumen narrows sufficiently to impede urine flow, obstructive symptoms arise. While the incidence of VUAS used to be notably higher prior to the widespread use of the robotic approach, traditional procedures still fail in up to 42% of cases. Initial management typically involves endoscopic procedures, such as dilation, incision, or resection. If these approaches prove ineffective, VUA reconstruction is warranted. Following the resection of the unhealthy urethra, a potential drawback is the insufficient length of the healthy proximal urethral to reach the bladder without tension. In such cases, urinary diversion with an ileal conduit is an option. However, when the patient prefers to maintain an orthotopic urinary tract configuration, there is limited guidance in the literature regarding surgical techniques. OBJECTIVE: To outline the indications, describe the step-by-step technique, and evaluate the outcomes of transperineal urethral advancement to facilitate a tension-free VUA. MATERIALS: We first discuss the indications to identify which patients are candidates for this procedure. Then, a step-by-step description of the robotic VUA revision assisted by transperineal urethral mobilization is presented. Detailed steps and helpful hints are included. Finally, we outline the postoperative pathway and expected outcomes. RESULTS: This technique allows patients with VUAS to preserve the orthotopic configuration of the urinary tract when a tension-free anastomosis proves challenging. Although urinary incontinence is expected, an artificial urinary sphincter could be placed in the following months. CONCLUSION: The robotic management of complex vesicourethral anastomosis stenosis with transperineal urethral advancement is a feasible and safe procedure that requires the interdisciplinary management of robotic and reconstructive urologists.
Assuntos
Procedimentos Cirúrgicos Robóticos , Uretra , Masculino , Humanos , Uretra/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos Urogenitais , Anastomose CirúrgicaRESUMO
Abstract | Introduction: The studies on knowledge, attitudes, and practices (KAP) regarding COVID-19 help to identify erroneous concepts and inadequate practices related to the disease. This baseline information is essential to design effective strategies and improve adherence to prevention measures. Objective: To identify the COVID-19-related KAP in Venezuelan patients screened at the Hospital Universitario de Caracas triage tent. Materials and methods: We conducted a cross-sectional study among 215 patients between April 25th and May 25th, 2020, with in-person interviews using a KAP survey. Results: Most surveyed patients (53.5%) were asymptomatic. Most of them, both from the symptomatic and the asymptomatic groups, had adequate knowledge about the symptoms and transmission of the disease and the majority said they were practicing quarantine, frequent handwashing, and the use of face masks in public areas. However, the daily replacement of cloth face masks was more frequent in the asymptomatic group whereas replacement every three days was more frequent in the symptomatic group. Finally, more than half of the participants admitted having been in crowded places, a common practice among the symptomatic compared to the asymptomatic patients. Conclusions: This is the first KAP study in Venezuela about COVID-19. Knowledge and practices among Venezuelans could be improved by strengthening education and training programs. This information from the early phase of the pandemic in Venezuela may contribute to the design of COVID-19 promotion and prevention strategies.
Resumen | Introducción. Los estudios de conocimientos, actitudes y prácticas (CAP) relacionados con la Covid-19 permiten establecer los conceptos erróneos y las prácticas inadecuadas en torno a esta enfermedad, información fundamental para diseñar estrategias eficaces y mejorar el cumplimiento de las medidas de prevención. Objetivo. Establecer los conocimientos, actitudes y prácticas relacionadas con la Covid-19 en pacientes venezolanos cribados en la carpa de triaje del Hospital Universitario de Caracas. Materiales y métodos. Se hizo un estudio transversal en 215 pacientes entre el 25 de abril y el 25 de mayo de 2020, mediante entrevistas personales y utilizando una encuesta sobre conocimientos, actitudes y prácticas. Resultados. La mayoría (53,5 %) de los pacientes encuestados se encontraba asintomática; los encuestados tenían un conocimiento adecuado sobre los síntomas y la transmisión de la enfermedad, sin distinción entre sintomáticos y asintomáticos. La mayoría de ellos indicó estar respetando las prácticas de cuarentena, lavado de manos frecuente y uso de tapabocas en público; sin embargo, el reemplazo diario de los tapabocas de tela fue más frecuente en el grupo de los asintomáticos, en tanto que el reemplazo cada tres días fue más común entre los sintomáticos. Por último, más de la mitad de los participantes admitió haber estado en lugares concurridos, siendo esta práctica más frecuente entre los sintomáticos que entre los asintomáticos. Conclusiones. Este es el primer estudio de conocimientos, actitudes y prácticas sobre la Covid-19 en Venezuela. El conocimiento y las prácticas de los venezolanos podrían mejorar mediante el fortalecimiento de los programas de educación y capacitación. Esta información, obtenida durante la fase inicial de la pandemia en Venezuela, podría contribuir al diseño de estrategias de promoción y prevención de la Covid-19.