Early coagulation function changes of penetrating intestinal firearm injury of pigs in high-altitude environment / 中华创伤杂志

Objective:To explore the early coagulation function changes of penetrating intestinal firearm injury of pig in high-altitude environments.Methods:Twenty healthy long white piglets were selected and divided into the plain group and the high-altitude group using the random number table method, with 10 pigs in each group. Pigs in the plain group were placed in a plain environment at an altitude of 800 meters, while pigs in the high-altitude group were placed in an experimental chamber simulating an altitude of 6 000 meters for 48 hours. Both groups received pistol gunshot to have firearm penetrating wounds to the abdominal intestinal tract and then returned to the plain observation room. At 0, 2, 4, 8, 12 and 24 hours after injury, coagulation in the peripheral blood and fibrinolytic indexes [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), D-dimer (D-D), and fibrinogen degradation product (FDP)], thromboelastogram (TEG) [reaction time (R), clotting time (K), clot formation rate (α), maximum amplitude (MA) and coagulation composite index (CI) ], platelet parameters [platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR)] in the two groups were detected separately.Results:The PT values at 0 and 2 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours than those in the plain group ( P<0.01); there was no significant difference at 4 hours between the two groups ( P>0.05). The APTT values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The TT values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.01); there was no significant difference at 8 hours after injury between the two groups ( P>0.05). The Fbg, D-D and FDP values at 0, 2, 4, 8, 12 and 24 hours after injury were higher in the high-altitude group than those in the plain group ( P<0.01). The R values at 0, 2 and 4 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The K values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly lower than those in the plain group, while they were significantly higher at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The α angles at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The MA values at 0, 2 and 4 hours after the injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The CI values at 0, 2 and 4 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 8, 12 and 24 hours after injury than those in the plain group ( P<0.01). The PLT values at 0, 2, 4 and 8 hours after injury in the high-altitude group were significantly higher than those in the plain group, while they were significantly lower at 12 and 24 hours after injury than those in the plain group ( P<0.05 or 0.01). The MPV values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.01). The PDW values at 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were significantly higher than those in the plain group ( P<0.05 or 0.01), while there was no significant difference in PDW at 0 hour after injury between the two groups ( P>0.05). The P-LCR values at 0, 2, 4, 8, 12 and 24 hours after injury in the high-altitude group were all significantly higher than those in the plain group ( P<0.01). Conclusion:Compared with the plain environments, pig intestinal firearm penetrating injury in the high-altitude environments is more prone to early hypercoagulable state accompanied by mild hyperfibrinolysis, and faster to reach a hypocoagulable state accompanied by obvious hyperfibrinolysis.

Suicidio por herida pérforo-cortante en el abdomen / Suicide by piercing-cutting wound to the abdomen

RESUMEN El suicidio es un problema humano que existe desde el origen mismo del hombre, ha sucedido en todas las épocas, ha afectado a ambos géneros y a diferentes clases sociales; varía sus características de acuerdo con la cultura y la estructura socio-económica. El uso de arma blanca como método suicida es relativamente poco común en el campo médico legal, por eso este tipo de casos es pobremente estudiado, lo que en ocasiones plantea variadas dificultades al momento de diferenciarlos de heridas producidas de manera homicida. Se presenta un individuo que falleció tras autoinfligirse heridas pérforo-cortantes en el abdomen, lo cual constituye un método poco común de suicidio en el contexto cubano.

ABSTRACT Suicide is a human problem that has existed since the very origin of man, it has happened at all times, and has affected both genders and different social classes; its characteristics vary according to culture and socio-economic structure. The use of edged weapons as a suicide method is relatively uncommon in the medical-legal field, that is why this type of case is poorly studied, because sometimes poses various difficulties when differentiating it from wounds produced in a homicidal manner. We present an individual who died after self-inflicted piercing-cutting abdominal stab wounds, which constitutes an uncommon method of suicide in the Cuban context.

Conducta selectiva en trauma penetrante de cuello / Selective management in penetrating neck trauma

Objetivo: evaluar la incidencia de hallazgosquirúrgicos positivos en pacientes con diagnóstico de traumapenetrante de cuello de dos instituciones hospitalariascapitalinas, sometidos a exploración quirúrgica inmediatao conducta selectiva. Métodos: en un estudio descriptivo,cuantitativo y transversal, se evaluaron 22 heridos condiagnóstico de lesiones penetrantes de cuello entre años 2017y 2021. Se dividieron en dos grupos de acuerdo al tipo deconducta aplicada. Las distintas frecuencias fueron expresadas ennúmero y porcentaje. Resultados: Grupo A, ocho heridos (36,4%), siete ingresaron con signos duros sometidos a exploraciónquirúrgica inmediata, el 87,5 % presentó hallazgos positivos ala cervicotomía; dos fueron incluidos en un esquema de cirugíade control de daños. Grupo B, catorce lesionados con signosblandos admitidos para conducta selectiva mediante observaciónfrecuente y realización de diversos estudios paraclínicos (63,6%),tres requirieron intervención operatoria por la presencia deenfisema subcutáneo expansivo después de las primeras 48 horas;se identificó una lesión esofágica, que se reparó con cierreprimario y rotación de colgajo muscular. Conclusión: En elpresente estudio, la incorporación de la conducta selectiva enel manejo multidisciplinario del trauma penetrante de cuellopermitió incrementar el número de exploraciones positivas yreducir las negativas. Nuevas estrategias como la cirugía decontrol de daños y la zona cero han sido incluidas en algunasheridas vasculares o lesiones extensas(AU)

Objective: To evaluate the incidence of positiveexplorations in patients with penetrating neck trauma oftwo capitals hospitals underwent to immediate surgicalexploration or selective management. Method: Studydescriptive, quantitative and transversal of twenty-two patientswith penetrating neck trauma since years 2017 to 2021. Distribute in two groups in the basis of the management.Different frequency express in frequency and percentages.Results: Group A, eight injured, 36.4 %. Seven with hardsigns, underwent immediate surgical exploration of the neck.the 87.5 % had positive explorations. Two were included in ascheme of surgery damaged control. Evidenced injuries extentsand for high velocity projectile. Group B, fourteen wounded,63.6 %. three required surgical intervention for the presence ofpersistent emphysema. One occult esophagical injury, repairedwith suture and muscular rotation. Conclusion: In the present study the selective management of penetrating neck traumapermit increase the number of positive explorations and reducethe negatives. this alternative was viable and secures(AU)

Evolución del traumatismo penetrante cardíaco operado / Penetrating cardiac injury: evolution of characteristics, severity and mortality in surgery treated patients

Resumen Introducción: El traumatismo penetrante cardíaco (TPC) es una lesión poco frecuente y con alta morbilidad y mortalidad. Objetivo: Analizar la evolución de características clínicas, anatómicas, gravedad, morbilidad y mortalidad de pacientes operados por TPC. Materiales y Métodos: Estudio analítico de pacientes tratados quirúrgicamente por TPC en Hospital Clínico Regional "Dr. Guillermo Grant Benavente", Concepción, Chile. Se analizaron los periodos: enero-1990 a diciembre-2004 y enero-2005 a diciembre-2019. Se comparó: sexo, edad, lesiones asociadas, agente y mecanismo del traumatismo, comportamiento fisiopatológico, ubicación anatómica de la lesión, clasificaciones del traumatismo cardíaco Attar, Saadia y OIS-AAST, IGT (índices de gravedad del traumatismo): ISS, RTS-T y TRISS, morbilidad y mortalidad según periodos. Se realizó análisis estadístico con SPSS25®, se utilizaron las pruebas chi-cuadrado, exacta de Fisher y Mann-Whitney. Se consideró significativo un valor p < 0,05. Resultados: Total 235 TPC, 112 en el primer periodo y 123 en el segundo. Mecanismo arma blanca en 96 (85,7%) y 104 (84,6%) según periodos. En el segundo periodo se observó un aumento de lesiones extratorácicas asociadas, paro cardiorrespiratorio y lesión de ubicación izquierda. Las clasificaciones del traumatismo cardíaco y los IGT ISS, RTS-T y TRISS mostraron mayor gravedad y probabilidad de muerte en los pacientes del segundo periodo. La mortalidad no mostró diferencias: 14 (12,5%) y 14 (11,4%) según periodos (p = 0,792). Discusión: En nuestra serie los pacientes tratados por TPC han evolucionado hacia un perfil de mayor gravedad tanto en parámetros fisiológicos como anatómicos. La mortalidad se ha mantenido estable a través del tiempo.

Background: Penetrating cardiac injury (PCI) is a rare injury with high morbidity and mortality. Aim: To analyze the evolution of clinical and anatomical characteristics, severity, morbidity and mortality of patients operated on by PCI. Materials and Methods: Analytical study of patients surgically treated for PCI at the "Guillermo Grant Benavente" Regional Clinical Hospital, Concepción, Chile. Two periods were analyzed: January-1990 to December-2004 and January-2005 to December-2019. Sex, age, associated injuries, trauma agent and mechanism, pathophysiological behavior, anatomic location of the injury, classifications of cardiac trauma: Attar, Saadia and OIS-AAST, TSI (trauma severity indices): ISS, RTS-T and TRISS, morbidity and mortality were compared according to periods. Statistical analysis was performed with SPSS25®, the chi-square, Fisher exact and Mann-Whitney tests were used. A p value < 0.05 was considered significant. Results: Total 235 PCI, 112 in the first period and 123 in the second. Stab as mechanism in 96 (85.7%) and 104 (84.6%) according to periods. An increase in associated extra thoracic injuries, cardiorespiratory arrest, and injury to the left location were observed in the second period. The cardiac trauma classifications and the TSI ISS, RTS-T and TRISS showed greater severity and probability of death in the second period patients. Mortality did not show differences: 14 (12.5%) and 14 (11.4%) according to periods, p = 0.792. Discussion: In our series, patients treated with PCI have evolved towards a more severity profile in both, physiological and anatomical parameters. Mortality has been stable over time.

Manejo laparoscópico de hernia diafragmática traumática: reporte de un caso / Laparoscopic management of traumatic diaphragmatic hernia: a case report

La hernia diafragmática traumática representa un reto al momento del diagnóstico. Una detección oportuna permite establecer un correcto tratamiento quirúrgico. Se presenta el caso de un paciente masculino de 37 años de edad con antecedente de trauma torácico por arma blanca 4 años antes; quien acude por cuadro de dolor abdominal intenso localizado en epigastrio que se irradia a hipocondrio izquierdo de aparición súbita 72 horas antes de su ingreso. Al examen físico murmullo vesicular disminuido en campo pulmonar izquierdo, y abdomen doloroso a la palpación a nivel de epigastrio e hipocondrio izquierdo. En exámenes de laboratorio no se evidencian alteraciones, mientras que la tomografía reporta hernia diafragmática izquierda; la misma que fue resuelta quirúrgicamente mediante técnica laparoscópica.

Traumatic diaphragmatic hernia represents a challenge at diagnosis. A timely detection allows to establish a correct surgical treatment. It is presented the case of a 37-year-old male patient with a history of stabbing chest trauma 4 years earlier; who comes for symptoms of intense abdominal pain located in the epigastrium that radiates to the left hypochondrium of sudden onset 72 hours before admission. On physical xamination, vesicular murmur decreased in the left lung field, and a painful abdomen on palpation at the level of the epigastrium and left hypochondrium were showed. Laboratory tests did not show any alterations, but tomography reports a left diaphragmatic hernia; this one was solved surgically by laparoscopic technique.

Fatores associados a óbitos por ferimentos por arma de fogo: em atendimentos móveis pré-hospitalares de um samu regional do Paraná / Factores asociados con muertes por lesiones causadas por armas de fuego: en servicios móviles prehospitalarios de un samu regional de Paraná / Factors associated with deaths from firearm injuries: in pre-hospital mobile care at a regional samu in Paraná

RESUMO Objetivo: analisar perfil sociodemográfico, morbimortalidade e distribuição espacial de vítimas de ferimentos por armas de fogo atendidas pelo serviço de atendimento móvel de urgência. Métodos: estudo transversal dos registros de atendimento de 603 vítimas de ferimento por arma de fogo atendidas pelo Serviço de Atendimento Móvel de Urgência. Utilizaram-se estatística descritiva, análise de associação univariada e mapa de Kernel para distribuição espacial. Resultados: a maioria das vítimas era do sexo masculino (94%), com idade entre 21 e 30 anos (61,5%). A maioria dos óbitos (73,7%) ocorreu nessa mesma faixa etária. A distribuição espacial demonstrou a maior parte das vítimas em municípios conurbados da região metropolitana, com elevada morbimortalidade. Conclusão: houve maior prevalência de vítimas e óbitos em homens, na faixa dos 21 aos 30 anos, com ferimento em cabeça e pescoço e múltiplos sítios. Nesta amostra não foi possível estabelecer relação estatística significativa entre as cidades das ocorrências, porém se notam focos bem expressivos nas cidades de Sarandi e Paiçandu. Os resultados podem fornecer subsídios para formular políticas públicas para prevenção da violência e preparo para atenção às emergências.

RESUMEN Objetivo: analizar el perfil sociodemográfico, la morbimortalidad y la distribución espacial de las víctimas de lesiones causadas por armas de fuego atendidas por el servicio móvil de urgencias. Métodos: estudio transversal de los registros de atención de 603 víctimas de lesiones por armas de fuego atendidas por el servicio móvil de urgencias. Se utilizó estadística descriptiva, análisis de asociación univariante y el mapa de Kernel para la distribución espacial. Resultados: la mayoría de las víctimas eran hombres (94%), entre 21 y 30 años de edad (61,5%). La mayoría de las muertes (73,7%) ocurrió en este mismo grupo de edad. La distribución espacial mostró la mayoría de víctimas en los municipios conurbados de la región metropolitana, con alta morbilidad y mortalidad. Conclusión: hubo mayor prevalencia de víctimas y muertes en hombres, entre 21 y 30 años, con lesiones de cabeza y cuello y múltiples lugares. A pesar de haberse observado focos bastante expresivos en las ciudades de Sarandí y Paiçandu, en esta muestra no se ha logrado establecer una relación estadísticamente significativa entre las ciudades de los incidentes. Los resultados podrían proporcionar información relevante para formular políticas públicas de prevención de la violencia y preparación para la atención de emergencias.

ABSTRACT Objective: to analyze the sociodemographic profile, morbidity and mortality and spatial distribution of victims of firearms injuries attended by the mobile emergency care service. Methods: cross-sectional study of the care records of 603 firearm injury victims attended by the Mobile Emergency Care Service. Descriptive statistics, univariate association analysis and Kernel map were used for spatial distribution. Results: most of the victims were male (94%), aged between 21 and 30 years (61.5%). Most deaths (73.7%) occurred in this same age group. The spatial distribution showed the majority of victims in conurbated municipalities in the metropolitan region, with high morbidity and mortality. Conclusion: there was a higher prevalence of victims and deaths in men, aged 21 to 30 years, with head and neck injuries and multiple sites. In this sample it was not possible to establish a statistically significant relationship between the cities of the occurrences, but there are quite expressive focuses in the cities of Sarandi and Paiçandu. The results can provide input to formulate public policies for preventing violence and preparing for emergency care.

Penetrating Wounds of the Upper Extremity - Prevalence and Etiology / Ferimentos penetrantes no membro superior - prevalência e etiologia

Abstract Objective To define the major epidemiological features of upper limb penetrating injuries, as well as to identify the causes and the frequency of these lesions at the Instituto de Ortopedia e Traumatologia, a hand surgery center in the city of São Paulo, state of São Paulo, Brazil. Methods The present study was based on a sample of consecutive patients from our orthopedics and traumatology institute from May 2014 to May 2016. Data were collected by telephone, and a prestructured questionnaire regarding data and features of the lesions was applied. Descriptive statistics and proportions comparison with the chi-squared test were performed with a p-value < 5% considered as statistically significant. Results At first, 1,648 records were considered and, after applying the exclusion criteria and eliminating duplicate records, 598 records were included in the present study. Most of the patients weremale (77.8%), right-handed (95.82%), with an average age of 37.27 years old.Manual laborers were the most injured individuals (50.00%), and fingers were the most affected site (51.84%). Glass was the most frequent etiologic agent (33.77%). The prevalence of amputation was higher in industrial machinery injuries (p < 0.05) when compared with other causes. Younger patients (< 18 years old) had more glass-related injuries, while older patients ( 60 years old) had more traumas caused by power tools (p < 0.05). Women had more injuries resulting from razors and glass (p < 0.05). Manual laborers had a higher frequency of power tools and industrial machinery-related injuries (p < 0.05) and a higher prevalence of amputations (p < 0.05). Conclusion Themost frequent etiology was glass, especially in individuals < 18 years old.Women and older patients (> 60 years old) presented a high frequency of traumas caused by razors and power tools, respectively. More severe injuries were caused by machinery and were related with work activity.

Resumo Objetivo Definir as principais características epidemiológicas dessas lesões, bem como identificar a causa e a frequência de ferimentos penetrantes no membro superior atendidos no Instituto de Ortopedia e Traumatologia da nossa instituição. Métodos O estudo se baseou em uma amostra de pacientes consecutivos atendidos no Instituto de Ortopedia e Traumatologia dessa instituição, demaio de 2014 amaio de 2016. Os dados foram coletados por contato telefônico, aplicou-se um questionário pré-estruturado sobre os dados e as características das lesões. A análise estatística foi feita de forma descritiva e a comparação das proporções através do teste de quiquadrado, associado ao valor de p, com significância < 5%. Resultados Foramconsiderados 1.648registros inicialmente e, após aplicados os critérios de exclusão e excluídos os duplicados, 598 pacientes foram incluídos na análise final. A maioria dos pacientes era do gênero masculino (77,80%), destros (95,82%), com média no momento do trauma de 37,27 anos. Os trabalhadores manuais foram os mais lesionados (50,00%) e a topografia mais acometida foram os dedos (51,84%). Dentre os agentes etiológicos, destaque para o vidro (33,77%). A prevalência de pacientes comamputação foi maior nos ferimentos por máquinas industriais (p < 0,05) quando comparada com outros agentes etiológicos. Pacientes com menos de 18 anos apresentaram maior frequência de ferimentos ocasionadas por vidro (p < 0,05). Já os pacientes com 60 anos ou mais apresentaram maior prevalência de ferimentos pormáquina de corte (p < 0,05). Mulheres apresentaram maior frequência de ferimentos por lâmina e por vidro (p < 0,05). Os trabalhadores manuais apresentaram maior prevalência de ferimentos por máquinas de corte e industriais (p < 0,05) e maior prevalência de amputações (p < 0,05). Conclusão O agente etiológico mais frequente é o vidro, com relevância maior em menores de 18 anos. Em mulheres e idosos, há grande frequência de lesões causadas por lâminas e máquinas de corte, respectivamente. Lesões de maior gravidade são causadas por máquinas, associadas a atividade laboral.

Long-term traumatic and asymptomatic aorto-right atrial fistula

Abstract Aorto-atrial fistulas due to cardiac trauma are rare, and survivors require immediate surgical correction. Here, we report a case of an aorto-right atrial fistula due to penetrating trauma after a 16-year evolution, which developed symptoms of acute coronary syndrome and was treated with myocardial revascularization and correction of the aorto-cameral fistula.

Amaurose por neuropatia óptica traumática direta secundária à corpo estranho transorbitário: relato de um caso atípico / Amaurosis by Traumatic Optic Neuropathy direct secondary to the "transorbitario" foreign body: Report of an atypical case

Resumo Neste trabalho descreve-se o caso clínico de um paciente do sexo masculino que evoluiu para cegueira tardia por neuropatia óptica traumática após queda de bicicleta. Enfatiza-se a importância do exame oftalmológico/reflexos pupilares e da tomografia computadorizada no diagnóstico de corpo estranho orbitário, sua remoção cirúrgica, abordagem interdisciplinar e evolução.

Abstract The purpose of this research is to describe a clinical study of a male patient who experienced late-blindness due to traumatic optic neuropathy after getting into a bicycle accident. It is stressed the importance of performing pupillary/reflexes examination and computed tomography scan in order to diagnose "transorbitário" foreign body. It is also cover its surgical removal as well as an interdisciplinary approach and clinical evolution.

The role of heart team approach in penetrating cardiac trauma: case report and review of the literature

Abstract Penetrating cardiac trauma has been increasing in clinical experience and is joined to important morbidity and mortality. A case of a 38-year-old female with history of postpartum depression was reported, admitted to our department for cardiac tamponade due to penetrating self-inflicted multiple stab wound of the chest complicated by rupture of anterior left ventricular wall and traumatic ventricular septal defect. Following the unstable hemodynamic instability, a combined therapeutic strategy was chosen: surgery and transcatheter implantation to correct free wall ventricle damage and traumatic ventricular septal defect, respectively.

Applications of digital subtraction angiography in the management of penetrating injuries of the maxillofacial region: A case report

This report presents a clinical case of trauma due to assault with a knife, and describes the importance of using the correct imaging modality in cases of facial penetrating trauma involving the superficial and deep anatomical planes. Penetrating wounds in the maxillofacial region are rare and poorly reported, but can result in serious complications that are difficult to resolve and may compromise the patient's quality of life, especially when large blood vessels or other vital structures are involved. Thus, it is essential to determine the extent of the affected blood vessels and the proximity of the retained object to the anatomical structures. In this case, digital subtraction angiography was the imaging modality chosen. The use of appropriate imaging examinations allows a proper map of the surgical field, reducing the chances of vascular damage during the surgical procedure.

Exposição a material biológico no ambiente ocupacional: conhecimento e adoção de condutas preventivas / Exposure to biological material in the occupational environment: knowledge and adoption of preventive measures

A Biossegurança em saúde é o conjunto de ações voltadas para a prevenção, minimização ou eliminação de riscos inerentes às atividades de pesquisa, produção, ensino, desenvolvimento tecnológico e prestação de serviços, visando à saúde do homem, dos animais, preservação do meio ambiente e qualidade dos resultados. No presente trabalho, procurou-se realizar uma revisão integrativa da literatura sobre biossegurança e precauções padrão na odontologia. Para isso, foi feita uma busca de evidências presentes na literatura científica, por meio de um levantamento nas bases de dados "Scielo" e no "Portal Regional da BVS", utilizando uma estratégia de busca de acordo com a temática proposta. Além disso, verificou-se, por meio de um questionário semiestruturado com perguntas relacionadas ao tema, o conhecimento e adesão às precauções padrão, em especial a prática de reencapar agulhas; as ações a serem tomadas diante acidentes e aspectos relativos à prevenção de infecções, por acadêmicos e funcionários da Faculdade de Odontologia de Araçatuba (FOA -Unesp). Observou-se a localização dos recipientes de descarte de perfurocortantes nas clínicas da faculdade, as condições de preenchimento e os materiais descartados nos recipientes do grupo E. Analisaram-se as informações contidas nas Notificações de Acidente de Trabalho (NATs), a fim de estabelecer um perfil dos acidentes ocorridos na faculdade. A partir das buscas nas bases de dados, foram encontrados 95 artigos sobre a temática nos últimos 10 anos. No entanto, obtivemos um total de 18 artigos selecionados para a presente revisão integrativa de literatura, os quais obedeceram criteriosamente os critérios de inclusão e exclusão, e se relacionavam com o objeto de estudo. Participaram da pesquisa 91 acadêmicos de odontologia dos últimos anos, dos períodos integral e noturno e 21 funcionários terceirizados da limpeza da faculdade. 55 NATs foram analisadas no período de 2013 a 2017. Entre os alunos que responderam ao questionário, 79 (86,8%) afirmaram existir um protocolo na faculdade em caso de acidente, 82 (90,1%) disseram ter recebido orientações a respeito e 42 (46,2%) afirmaram saber o que são as PP. Entretanto, 74 (81,3%) afirmaram reencapar agulhas, na maioria dos casos com uma das mãos (78,4%), a fim de não deixar a agulha exposta na bancada (71,4%). 31 (34,1%) já sofreram acidentes com material biológico, sendo que 62 (68,1%) não sabiam quais os cuidados imediatos pós-exposição, 87 (95,6%) o prazo máximo para o início da profilaxia pós-exposição ao HIV, 78 (85,7%) a duração e 74 (81,3%) a eficácia. 63 (69,2%) não receberam orientação sobre o preenchimento da NAT. Entre os funcionários, 17 (81%) afirmaram existir um protocolo na faculdade em caso de acidente e terem recebido orientações a respeito; entretanto 7 (33,3%) não sabiam o que eram as PP. 20 (95,3%) não conheciam quais os cuidados imediatos pós-exposição, 18 (85,7%) não sabiam o prazo máximo para o início da profilaxia pós-exposição ao HIV, 20 (95,3%) a duração e a eficácia. Apesar de 9 (42,9%) afirmarem ter recebido orientação sobre o preenchimento da NAT, 11 (52,4%) não conheciam ou não responderam qual seria o prazo máximo para seu preenchimento. Em relação ao recipiente de descarte, a localização mostrou-se inadequada, pois o aluno precisava deslocar-se para realizar o descarte. Observaram-se 7.327 agulhas descartadas, onde 3.587 (49%) estavam reencapadas, dentre as quais 2.555 (71,2%) em um lado e 1.032(28,8%) em ambos os lados; além disso, foram verificados diferentes materiais não perfurocortantes descartados, como tubetes anestésicos, gaze e algodão. Em relação as NATs, a maioria foi emitida no ano de 2017 (45,4%), 50 (90,9%) eram do sexo feminino e tinham a média de idade de 48,78 anos (dp=9,52). 53 (96,4%) correspondiam à ocorrência de acidentes típicos, onde na maioria dos casos, a parte do corpo mais atingida foi às mãos (40%) e 12 (21,8%) dos pesquisadores pediram afastamento após o infortúnio. 29 (52,7%) dos acidentes ocorreram em uma unidade auxiliar de estrutura complexa da faculdade. Conclui-se que há alto percentual de acidentes com material biológico, em especial entre acadêmicos, além de deficiência no conhecimento das condutas pós-exposição e baixa adesão de medidas preventivas entre ambas as categorias pesquisadas; também o predomínio da ocorrência de acidentes em um setor específico da faculdade(AU)

Standard Precautions (SP) are recommendations, among them, the not recapping needles, which purpose is to minimize or prevent the transmission risk of blood borne pathogens. This study objective was to verify the knowledge and adhesion to the SP, especially the recapping needles practice; the actions to be taken before accidents and related aspects to infection prevention by academics and employees; besides the profile of accidents occurred in the Faculdade de Odontologia de Araçatuba (FOA - Unesp). Also observe the location of the sharps disposal containers in the school clinics, the filling conditions and disposed materials. Was applied a semi-structured questionnaire with related questions to 91 senior students from both periods and 21 outsourced cleaning staff from the school. Was also analyzed the information on the Employee's Report of Injury. Between the academics, 79 (86.8%) affirmed the existence of an accident protocol, 82 (90.1%) had received orientation about it and 42 (46.2%) affirmed to know what are the SP. However, 74 (81.3%) affirmed to recap needles, mostly using one hand (78.4%), in order to not let the needle exposed in the table (71.4%). 31 (34.1 %) already suffered an accident with biological material, being that 62 (68.1%) did not know the immediate post exposure care, 87 (95.6%) the maximum time to initiate the HIV post exposure prophylaxis, 78 (85.7%) the duration and 74 (81.3%) the efficiency. 63 (69.2%) did not received an orientation about the Employee's Report Injury. Among the staff, 17 (81 %) affirmed the existence of an accident protocol and have received orientation about it; however, 7 (33.3%) did not know the SP. 20 (95.3%) did not know the immediate post exposure care, 18 (85.7%) ignored the maximum time to initiate the HIV post exposure prophylaxis, 20 (95.3%) the duration and the efficiency. Despite of 9 (42.9%) affirmed to have received orientation about the Employee's Report of Injury, 11 (52.4%) ignored or did not responded about the maximum time to submit it. About the sharp disposal container, the location showed was inappropriate, once the academic had to move to realize the disposal. There was 7.327 needles disposed, where3.587 (49%) was recapped, being that 2.555 (71.2%) in one end and 1.032 (28.8%) in both ends; in addition, was noticed that non-sharpened materials, as anesthetic tubes, gauze and cotton. Was analyzed 51 Employee's Report of Injury in a period, being that 47 (92.2%) of the injured were female. 14 (25.7%) reports in volved sharp materials, and the body part were the hands. 36 (70.6%) of the injury occurred in an auxiliary unit of complex structure. It concludes that there is a high percentage of biological material accidents, especially among academics, and a deficiency in the knowledge about post exposure measures and low adhesion among both surveyed categories, besides the predominance of the occurrence of accidents in an specific sector of the school(AU)

Embolization by Bullet Dislodged from the Heart

Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery.

Tomographic aspects of penetrating thoracic trauma: injuries from firearms and other weapons / Aspectos tomográficos do trauma torácico aberto: lesões por projéteis de arma de fogo e armas brancas

Abstract Objective: The aim of this study was to analyze the various computed tomography findings in penetrating chest trauma, as well as to determine the frequency and extent of the lesions. Material and Methods: We studied the computed tomography findings from 40 cases of penetrating thoracic trauma, of which 35 (85.8%) were gunshot wounds and 5 (14.2%) were caused by another type of weapon. Results: Pulmonary lesions were found in 39 cases (97.5%), manifesting as contusions in 34 cases (85%), atelectasis in 8 (20%), lacerations in 1 (2.5%) and hematomas in 1 (2.5%). Hemothorax was seen in 31 cases (77.5%), and pneumothorax was seen in 22 cases (55%). Mediastinal lesions were observed in 8 cases (20%), including mediastinal hematoma in 3 cases (7.5%), hemopericardium in 3 (7.5%), and pneumomediastinum in 2 (5%). Diaphragmatic rupture was seen in 2 cases (5%). Conclusion: In patients with penetrating thoracic trauma, computed tomography of the chest is an important tool for characterizing the affected organs and evaluating the path of injury, as well as the severity and extent of the lesions. The images obtained are also useful in estimating the risk of death and determining the best therapeutic approach.

Resumo Objetivo: Analisar os diferentes achados da tomografia computadorizada no trauma torácico aberto e determinar sua frequência e extensão. Materiais e Métodos: Neste trabalho foram estudados os aspectos tomográficos de 40 pacientes com trauma torácico aberto, sendo 35 casos causados por lesão por arma de fogo (85,8%) e 5 por arma branca (14,2%). Resultados: As lesões pulmonares predominaram, tendo sido observadas em 39 casos (97,5%), manifestadas sob a forma de contusões em 34 (85%), atelectasias em 8 (20%), lacerações em 1 (2,5%) e hematomas em 1 (2,5%). Hemotórax foi demonstrado em 31 casos (77,5%) e pneumotórax em 22 casos (55%). Lesões mediastínicas estiveram presentes em 8 casos (20%), com hematoma mediastínico em 3 casos (7,5%), hemopericárdio em 3 (7,5%) e pneumomediastino em 2 (5%). Lesão diafragmática foi observada em 2 pacientes (5%). Conclusão: A tomografia computadorizada de tórax, nos casos de trauma torácico aberto, permite caracterizar os órgãos acometidos, avaliar o trajeto das lesões, sua gravidade e extensão, sendo útil na estimativa de risco de vida e na escolha das abordagens terapêuticas.

Retenção de projéteis de arma de fogo na face: relato de casos / Firearms projectiles retention in the face: cases report

As agressões por arma de fogo podem trazer consequências devastadoras para a face e para a vida do indivíduo, sobretudo quando ferimentos extensos, fraturas e retenção dos projéteis estão envolvidos, podendo tornar o tratamento bem desafiador. Quando o ferimento é penetrante e os projéteis ficam alojados no organismo, adiciona-se complexidade ao quadro, pois muitas complicações podem surgir. É imprescindível que a tomada de decisão pela abordagem cirúrgica ou conservadora em relação aos objetos alojados leve em consideração critérios clínicos, cirúrgicos e anatômicos, a fim de trazer melhor qualidade de vida e menor morbidade ao paciente. Dessa forma, o objetivo deste estudo é revisar e discutir os aspectos do ferimento penetrante por Projétil de Arma de Fogo e ilustrar por meio de cinco casos clínicos, diferentes condutas em relação ao manejo desses objetos quando retidos na face... (AU)

The assaults with firearms can lead devastating consequences for the face and the life of the individual, especially when large wounds, fractures and retention of projectiles are involved, can become quite challenging treatment. When the wound is penetrating and projectiles are housed in the body, it adds complexity to the frame, since many complications can arise. It is essential that the light decision making by surgical or conservative approach to staying objects take into account clinical, surgical and anatomical criteria to bring better quality of life and less morbidity to the patient. Thus, the aim of this study is to review and discuss aspects of penetrating injury by Projectile Firearms and illustrate through five clinical cases, different conduct in relation to the management of these projectiles when retained in the face... (AU)

Trauma facial: ferimento por arma branca. Relato de caso / Facial trauma: cutting weapon injury. Case report

O trauma facial penetrante pode ser perigoso e, muitas vezes, fatal. O tratamento dos ferimentos penetrantes é um desafio por causa do difícil acesso e possível comprometimento de estruturas nobres. Muitas estruturas anatômicas podem ser atingidas, causando lesões oftalmológicas, neurológicas, hemorragias e obstrução das vias aéreas, o que pode tornar-se uma ameaça à vida. Os ferimentos faciais variam muito e apresentam diferentes graus de complexidade, merecendo uma abordagem emergencial e multidisciplinar. O presente trabalho apresenta um relato de caso sobre agressão com arma branca com subsequente trauma em face

Penetrating facial trauma can be dangerous and often fatal. The treatment of penetrating wounds is a challenge because of the difficult access and possible compromise of noble structures. Many anatomical structures can be affected, causing ophthalmological, neurological, hemorrhage and obstruction of the airways, which can become a life threat. Facial injuries vary widely and present different degrees of complexity, deserving an emergency and a multidisciplinary approach. The present paper presents a case report of aggression with subsequent facial trauma by a cutting weapon

Remoção de corpo estranho em seio maxilar: relato de caso / Removal Strange Body to the Maxillary Sinus: Case Report

Corpos estranhos no interior do seio maxilar são de ocorrência rara, e sua etiologia pode resultar de diferentes fatores, como traumas penetrantes ou iatrogenias. O diagnóstico nem sempre é fácil, e o uso de exames complementares de imagem são fundamentais para auxílio no diagnóstico e planejamento cirúrgico. A técnica de Caldwell-luc é sugerida por apresentam várias vantagens, como fácil emprego, inspeção e tratamento das enfermidades que o acometem. Este artigo relata o caso clínico de um paciente com corpo estranho no seio maxilar cuja remoção deste, foi realizada com sucesso por meio da técnica de Caldwell-Luc... (AU)

Foreign bodies inside the maxillary sinus are rare and its etiology can result from different factors such as penetrating trauma or iatrogenic. The diagnosis is not always easy and the use of imaging exams are critical to aid in the diagnosis and surgical planning. The Caldwell- Luc technique is suggested by a number of advantages like easy job, inspection and treatment of diseases that affect it. This article reports a case of a patient with foreign body in the maxillary sinus, whose removal this was successfully accomplished by Caldwell-Luc technique... (AU)

Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital / Análise epidemiológica de politraumatizados com lesões renais em um hospital universitário

Objective: To analyze the characteristics of trauma patients with renal lesions treated at a university hospital in Curitiba. Methods: We conducted a retrospective, cross-sectional study guided by review of medical records of trauma victims who underwent surgical treatment. The variables analyzed were age, gender, mechanism of injury, degree of kidney damage, conduct individualized according to the degree of renal injury, associated injuries, complications and deaths. We classified lesions according to the American Association of Trauma Surgery (TSAA). Results: We analyzed 794 records and found renal lesions in 33 patients, with mean age 29.8 years, most (87.8%) being male. Penetrating trauma accounted for 84.8% of cases. The most common renal injuries were grade II (33.3%), followed by grade I (18.1%), III, IV and V. Nephrectomy treated 45.4% of injuries, 73.3% being total nephrectomy, and 45.4% by nephrorraphy. In 9% treatment was non-surgical. Only 12.1% of patients had isolated renal lesions. Complications ensued in 15.1% and mortality was 6.06%. Conclusion: The surgical approach was preferred due to penetrating trauma mechanism. We achieved low rates of complications and deaths, and neither case could be directly related to kidney damage, and there were patients with multiple lesions. In this sample, we could not observe a direct relationship between kidney damage and complications, deaths or the type of conduct employed.

Objetivo: analisar as características de pacientes vítimas de trauma, com lesões renais atendidos em um hospital universitário de Curitiba. Métodos: estudo transversal retrospectivo guiado por revisão de prontuários de vítimas de trauma submetidos ao tratamento cirúrgico. As variáveis analisadas foram idade, sexo, mecanismo de trauma, grau das lesões renais, conduta individualizada de acordo com o grau da lesão renal, lesões associadas, complicações e óbitos. As lesões foram classificadas de acordo com a Associação Americana de Cirurgia do Trauma (AAST). Resultados: foram analisados 794 prontuários, a lesão renal foi encontrada em 33 pacientes, a média de idade foi 29,8 anos, a maioria dos pacientes era (87,8%) do sexo masculino. O trauma penetrante foi responsável por 84,8% dos casos. As lesões mais frequentes foram as de grau II (33,3%), seguidas pelas lesões de grau I (18,1%) e pelas lesões de grau III, IV e V. Foram tratadas com nefrectomia, 45,4% das lesões, 73,3% por nefrectomia total e 45,4%, por nefrorrafia. Em 9% o tratamento não foi cirúrgico. Apenas 12,1% dos pacientes apresentaram lesões renais isoladas. Complicações foram observadas em 15,1% e a taxa de óbito foi 6,06%. Conclusão: a abordagem cirúrgica foi a preferencial devido ao mecanismo de trauma penetrante. Obtivemos baixos índices de óbitos e complicações, sendo que nenhum dos casos pôde ser relacionado diretamente à lesão renal, e ocorreram em pacientes com múltiplas lesões. Nesta amostra, não foi possível provar relação direta entre lesão renal e complicações, óbitos ou com o tipo de conduta empregada.