Avaliação do colírio de brimonidina 0, 2% em comparação à nafazolina 0,025% + feniramina 0,3% nas cirurgias de estrabismo / Evaluation of 0.2% brimonidine eye drops compared to 0.025% naphazoline + 0.3% pheniramine in strabismus surgery

RESUMO Objetivo: Avaliar o efeito do colírio de brimonidina 0,2% na redução da hiperemia e do sangramento ocular durante as cirurgias de estrabismo, em comparação com o colírio de nafazolina 0,025% + feniramina 0,3%. Métodos: Foram avaliados 14 pacientes com estrabismo e indicação de correção cirúrgica bilateral. Foi instilado antes do procedimento, de forma aleatória, um colírio em cada olho dos pacientes avaliados. A análise subjetiva da hiperemia conjuntival e do sangramento perioperatório foi realizada de forma duplo-cega, por dois cirurgiões. A avaliação objetiva do nível de hiperemia conjuntival foi realizada por análise das imagens obtidas por meio do software ImageJ®. Resultados: A análise de modelos multivariados de efeito misto indicou diferenças estatisticamente significantes entre os grupos em relação à hiperemia (avaliador 2) e ao sangramento intraoperatório (avaliadores 1 e 2), com maiores escores nos casos tratados com colírio de nafazolina + feniramina. Entretanto, não houve diferença estatística na análise objetiva realizada por meio da saturação de cores obtidas pelo programa ImageJ®. Conclusão: O colírio de brimonidina pode ser superior ao colírio de nafazolina + feniramina na redução do sangramento, levando-se em conta apenas a análise subjetiva.

ABSTRACT Objective: To evaluate the effect of 0.2% brimonidine eye drops in reducing hyperemia and ocular bleeding during strabismus surgeries, in comparison with 0.025% naphazoline + 0.3% pheniramine eye drops. Methods: Fourteen patients with strabismus and indication for bilateral surgical correction were evaluated. Before the procedure, the eye drops were instilled randomly in each eye of the evaluated patients. The subjective analysis of conjunctival hyperemia and perioperative bleeding was performed in a double-blind manner, by 02 surgeons. The objective assessment of the level of conjunctival hyperemia was performed by analyzing the images obtained using the ImageJ® software. Results: The analysis of multivariate mixed effect models indicated statistically significant differences between the groups in relation to hyperemia (rater 2) and intraoperative bleeding (raters 1 and 2) with higher scores in cases treated with naphazoline + pheniramine eye drops. However, there were no statistically significant differences in the objective analysis of color saturation obtained by the ImageJ® program. Conclusion: Brimonidine eye drops may be superior to naphazoline + pheniramine eye drops in reducing bleeding, taking into account the subjective analysis only.

Successful management of iatrogenic tear in vitrectomy for retinopathy of prematurity-related retinal detachment: a case report / Tratamento bem-sucedido de rotura iatrogênica em vitrectomia para descolamento de retina por retinopatia da prematuridade: relato de caso

ABSTRACT Retinal detachment related to retinopathy of prematurity is a surgical challenge, and vitrectomy can directly release transvitreal traction resulting from fibrous proliferation. The presence of iatrogenic breaks is a poor prognostic factor and has been considered a dismal prognosis. We report a case of premature female baby that underwent a 3-port 23-Gauge pars plana vitrectomy for stage 4A retinopathy of prematurity, with intraoperative progressive rhegmatogenous detachment complication. Lensectomy, extensive membrane dissection and vitreous shaving, followed by a posterior retinotomy, fluid air exchange, extensive peripheral photocoagulation and C3F8 15% injection were performed. Successful anatomical result was obtained.

RESUMO O descolamento de retina relacionado à retinopatia da prematuridade é um desafio cirúrgico, e a vitrectomia é um procedimento capaz de romper diretamente a tração vitreorretiniana resultante da proliferação fibrosa. A presença de roturas iatrogênicas é um fator prognóstico ruim e tem sido considerada como prognóstico sombrio. Relatamos um caso de bebê prematuro do sexo feminino que foi submetido à vitrectomia via pars plana (23 Gauge; três incisões), para retinopatia da prematuridade estágio 4A, complicada por descolamento regmatogênico progressivo intraoperatório. Foram realizadas lensectomia, dissecção extensa da membrana e aspiração vítrea, seguidas de retinotomia posterior, troca fluido-ar, fotocoagulação periférica extensa e injeção de C3F8 a 15%. O resultado anatômico bem-sucedido foi obtido.

Patient positioning in minimally invasive gynecologic surgery: strategies to prevent injuries and improve outcomes

Abstract Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes.

Laparoscopic cholecystectomy for symptomatic cholelithiasis in children and adolescents: analysis of 50 cases from a single institution

Purpose: To investigate the clinical characteristics of symptomatic cholecystolithiasis and laparoscopic cholecystectomy complications in pediatric patients. Methods: The medical records of 50 children and adolescents who underwent laparoscopic cholecystectomy were analyzed. We evaluated gender, age, body mass index, preoperative clinical aspects, perioperative complications, and gallstone composition. Results: Among the patients, 33 (66%) were female, and 17 (34%) were male. The mean age was 11.4 ± 3.6. All patients were diagnosed with cholecystolithiasis by abdominal ultrasonography. Twelve patients (24%) had hematological disease: eight (16%) with sickle cell anemia and four (8%) with hereditary spherocytosis. Thirteen patients (26%) were obese. Twelve patients (24%) had complicated biliary disease. During the intraoperative period, three patients (6%) had excessive bleeding in the hepatic hilum, and one had an accidental injury to the common bile duct. Three (6%) postoperative complications (acute pancreatitis, common bile duct stenosis, and intestinal obstruction) were observed. Among 28 patients (56%), 25 (50%) had cholesterol gallstones, and three (6%) had bile pigment gallstones. Conclusions: The evolution of cholecystolithiasis in the pediatric population can present serious complications, emphasizing the need to avoid temporizing cholecystolithiasis in children and adolescents because laparoscopic cholecystectomy in this group is safe, with low complication rates.

El rol del factor humano en el éxito de la práctica clínica odontológica / The role of the human factor in the success of dental clinical practice

Los fracasos y complicaciones en el campo de la cirugía bucal son analizados generalmente desde un punto de vista técnico o biológico. En términos generales, a partir del es- píritu fragmentario del conocimiento, se tiende a enfocar la atención odontológica en la parte técnica y teórica. Actual- mente se están produciendo cambios socioculturales que están generando modificaciones en los paradigmas de la atención odontológica, considerando también la comunicación con el paciente y la situación psicológica tanto del paciente como del equipo profesional. En este editorial se busca reflexionar so- bre estos temas analizando perspectivas más integradas para lograr un mayor equilibrio en la atención profesional (AU)

Failures and complications in the field of oral surgery are generally analyzed from a technical or biological point of view. In general terms, based on the fragmentary spirit of knowledge, dental care tends to be focused on the technical and theoretical knowledge. We are currently witnessing so- ciocultural changes that are producing modifications in the paradigms of dental care, also considering communication with the patient and the psychological situation of both the patient and the professional team. This editorial seeks to re- flect on these issues, considering the most integrated visions to achieve greater balance in professional care (AU)

Lesión quirúrgica de la vía biliar en residentes. Experiencia de un Centro Formador Universitario / Surgical injury of the biliary tract in residents. Experience of a University Training Center

La lesión quirúrgica de la vía biliar es una complicación peligrosa de la colecistectomía, con importantes secuelas postoperatorias para el paciente en términos de morbilidad, mortalidad y calidad de vida. Tienen una incidencia laparoscópica estimada del 0,4% al 1,5% y del 0,2% al 0,3% en la colecistectomía convencional. El objetivo de este estudio fue evaluar la incidencia de LQVB durante la formación del cirujano y la importancia de realizar colangiografía intraoperatoria (COI) durante esta etapa

Bile duct surgical injury is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality and quality of life. These have an estimated laparoscopic incidence of 0.4% to 1.5% and 0.2% to 0.3% in conventional cholecystectomy. The aim of this study was to evaluate the incidence of LQVB during surgeon training and the importance of performing intraoperative cholangiography (IOC) during this stage

Desplazamiento de Tercer Molar Inferior a Espacio Submandibular: Reporte de Caso y Revisión de Literatura / Lower Third Molar Displacement to Submandibular Space: Case Report and Literature Review

El desplazamiento de un tercer molar a un espacio anatómico adyacente, ya sea en su totalidad o un fragmento de este, se encuentra descrito como una complicación rara pero posible de las exodoncias de terceros molares. En este reporte se aborda específicamente el desplazamiento accidental de un tercer molar inferior hacia el espacio submandibular izquierdo, el cual fue resuelto quirúrgicamente mediante un abordaje intraoral bajo anestesia general por el equipo de cirugía maxilofacial del Hospital de Urgencia Asistencia Pública, Santiago, Chile. Se realizó una revisión de literatura en la plataforma PubMed con las palabras claves "third molar - submandibular - displacement" obteniendo un total de 17 artículos en los cuales se reportan 15 casos. El propósito del presente escrito fue presentar recomendaciones sobre el manejo actual de esta complicación en base a la literatura disponible.

The displacement of a third molar into an adjacent anatomical space, either in its entirety or a fragment of it, has been described as a rare but posible complication of third molar extractions. This report will specifically address the accidental displacement of a lower third molar into the left submandibular space, which was surgically removed through an intraoral approach under general anesthesia, by the maxillofacial surgeon team of "Hospital de Urgencia Asistencia Pública", Santiago, Chile. An literature review was carried out on PubMed platform with the keywords ""third molar - submandibular - displacement"", obtaining a total of 17 articles where are reported 15 cases. The purpose of this paper is to present recommendations on the current management of this complication based on the available literature.

Manejo quirúrgico de bad split bilateral en cirugía ortognática / Surgical management of bilateral bad split during orthognathic surgery

El bad split es un término clínico que refiere a una fractura no planificada que ocurre al momento de realizar una osteotomía sagital de rama mandibular (OSRM). Afecta aproximadamente al 2,3% de los pacientes y se han descrito factores de riesgo tales como la presencia de terceros molares mandibulares, edad avanzada al momento de la cirugía, técnica de osteotomía inadecuada, entre otros. Se recomienda efectuar manio-bras preventivas para evitar la aparición de patrones de fractura no deseados al realizar la OSRM. Sin embargo, al momento de pesquisar un bad split, éste debe ser tratado por un equipo capacitado y de manera oportuna para evitar retardo en la consolidación, infecciones y secuestros óseos que puedan comprometer los resultados de la cirugía. En este artículo se presenta el manejo de un caso clínico de bad split bilateral intraoperatorio por el Servicio de Cirugía Maxilofacial del Hospital San José, enfatizando su tratamiento quirúrgico.

Bad Split is a clinical term referring to an unplanned fracture that occurs during the bilateral sagittal split osteotomy (BSSO). It affects approximately 2,3% of the patients undergoing orthognathic surgery and several risk factors have been described such as the presence of mandibular third molars, advanced age at the moment of orthognathic surgery, inadequate osteotomy technique, etc. Preventive maneuvers are recommended in order to avoid the appearance of undesired fracture patterns during BSSO. However, if a bad split is detected it must be managed and treated by a qualified team to avoid further complications such as delayed bone consolidation, bone infection and necrosis. In this article we present the management of a case of bilateral bad split by the Maxillofacial Surgery Service of Hospital San José, emphasizing on its surgical treatment.

Manejo de las complicaciones durante la cirugía endoscópica nasosinusal / Complication Management during Nasosinusal Endoscopic Surgery

Introducción: La cirugía endoscópica nasosinusal ha evolucionado de forma importante desde su creación. La posición anatómica que ocupan las cavidades nasosinusales con importantes estructuras adyacentes hacen que sus complicaciones, aunque raras, traigan secuelas irreversibles e incluso la muerte del paciente. Objetivo: Realizar una revisión sobre los tipos de complicaciones, frecuencia y su manejo durante la cirugía endoscópica nasosinusal. Métodos: Revisión documental en bases de datos bibliográficos sobre el tema durante el período de diciembre 2021 a enero 2022. Se seleccionaron 27 artículos relacionados con el objetivo propuesto y se desarrolló un documento resumen con la información recolectada. Desarrollo: La clasificación más utilizada separa las complicaciones en tres grados de severidad y las tasas de complicaciones mayores están por debajo del 1 por ciento en manos de cirujanos experimentados. Reconocer los sitios de mayor riesgo y los síntomas que puedan aparecer en el paciente son fundamentales para el rápido manejo de la complicación. Conclusiones: La cirugía endoscópica nasosinusal ha demostrado ser una excelente herramienta para el tratamiento quirúrgico de las enfermedades de estas cavidades en manos experimentadas. Aunque las tasas de complicaciones son ínfimas, saber reconocerlas y tratarlas a tiempo resulta fundamental(AU)

Introduction: Endoscopic nasosinusal surgery has evolved significantly since its inception. The anatomical position of the nasosinusal cavities, with important adjacent structures, means that its complications, although rare, bring about irreversible sequelae, and even death, for the patient. Objective: To review the types and frequency of complications, as well as their management, during endoscopic nasosinusal surgery. Methods: A documentary review on the subject was conducted in bibliographic databases during the period from December 2021 to January 2022. Twenty-seven articles related to the proposed objective were selected, while a summary document was developed with the collected information. Development: The most commonly used classification separates complications into three degrees of severity and includes major complication rates below 1 percent in the hands of experienced surgeons. Recognizing the sites of greatest risk and the symptoms that may appear in the patient are fundamental for the rapid management of the complication. Conclusions: Endoscopic nasosinusal surgery has proven to be an excellent tool for the surgical treatment of the diseases of these cavities in experienced hands. Although complication rates are minimal, it is essential to know how to identify and treat them(AU)

Escisión meso-rectal total por vía trans anal (TaTME). Experiencia institucional / Trans anal total meso-rectal excision (TaTME). Institutional experience

Introducción. La cirugía es la base del tratamiento curativo del cáncer de recto. La escisión meso-rectal total ha permitido mejorar los desenlaces oncológicos, disminuyendo las tasas de recurrencia locorregional e impactando en la supervivencia global. El empleo de esta técnica en los tumores de recto medio o distal es un reto quirúrgico, en el que la vía trans anal, permite superar las dificultades técnicas. Método. Se realizó un estudio observacional retrospectivo, recolectando la información de los pacientes con cáncer de recto medio y distal llevados a cirugía con esta técnica, en dos instituciones de cuarto nivel en Medellín, Colombia, entre enero de 2017 y marzo de 2022. Se analizaron sus características demográficas, la morbilidad perioperatoria y la pieza quirúrgica. Resultados. Se incluyeron 28 pacientes sometidos al procedimiento trans anal y laparoscópico de forma simultánea; al 57 % se les realizó una ileostomía de protección. Hubo complicaciones en el 60,7 % de los pacientes; ocurrieron cuatro casos de fuga anastomótica. No se presentó ninguna mortalidad perioperatoria. Conclusiones. La tasa de morbilidad perioperatoria es acorde con lo reportado en la literatura. Se resalta la importancia de la curva de aprendizaje quirúrgica y de incluir la calificación de la integridad meso-rectal dentro del informe patológico. Se requiere seguimiento a largo plazo para determinar el impacto en desenlaces oncológicos, calidad de vida y morbilidad

Introduction. Surgery is the pillar of curative treatment for rectal cancer. Total meso-rectal excision has improved oncological outcomes, decreasing locoregional recurrence rates and impacting overall survival. The use of this technique in tumors of the middle or distal rectum is a surgical challenge, in which the trans anal route allows overcoming technical difficulties. Method. A retrospective observational study was carried out, collecting information from patients with middle and distal rectal cancer undergoing surgery with this technique, in two level 4 institutions in Medellín, Colombia, between January 2017 and March 2022. Results. Twenty-eight patients were included; their demographic characteristics, perioperative morbidity, and surgical specimen were analyzed. All patients underwent the trans anal and laparoscopic procedures simultaneously; 57% underwent a protective ileostomy. There was no perioperative mortality. Complications occurred in 60.7% of the patients. Only four cases of anastomotic leak occurred. Conclusions. The perioperative morbidity rate is consistent with that reported in the literature; the importance of the surgical curve and to include the qualification of the meso-rectal integrity within the pathological report is highlighted. Long-term follow-up is required to determine the impact on oncological outcomes, quality of life, and morbidity

Prevalence of preoperative anxiety and its contributing factors in adult patients undergoing elective orthopaedic surgery at an academic hospital in South Africa: a pilot study

Preoperative anxiety potentially results in perioperative anaesthetic complications. This study aimed to determine the prevalence of preoperative anxiety in adult patients scheduled to undergo elective orthopaedic surgery at an academic hospital in South Africa and identify contributory factors. Methods: This cross-sectional study included all patients scheduled for elective orthopaedic surgery the following day from 25 July to 3 November 2021. An adapted version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used. Four questions determined the patients' anxiety and two questions their desire for more information about their forthcoming anaesthesia and surgery. A 5-point Likert scale was used to capture the patients' responses to the APAIS questions. Data on other possible contributory factors to preoperative anxiety were collected using a questionnaire. Results: Of the 88 patients, 82 (93.2%) were included in the study. A total of 40 (48.8%) patients had an APAIS score of ≥ 11, indicating anxiety. A high need-for-information score (≥ 8) was found in 31 (37.8%) patients. A significant association between patients with a higher anxiety score and a higher need-for-information score (p = 0.0063) was identified. Other non-significant factors associated with a higher anxiety score included a lower level of education and no postoperative home support. Conclusion: Patients with a high need for information tended to be more anxious on the day before surgery. The APAIS could be introduced in preoperative ward admissions to identify these patients and provide an appropriate level of counselling about their planned procedure. Counselling might reduce their preoperative anxiety, but further research needs to confirm this assertion. Larger studies are recommended to determine the influence of other factors contributing to preoperative anxiety

Análisis de datos intra y postquirúrgicos en exodoncias unitarias realizadas por alumnos de grado de la FOUBA / Analysis of intra and post-surgical data in single extractions performed by FOUBA undergraduate studens

La exodoncia es el procedimiento odontológico más antiguo del que se tiene registro, pero pocas publi-caciones abarcan con detalle esta temática. Conocer los pormenores de esta práctica puede servir para generar políticas educativas, sanitarias, como así también sistematizarla y bajar así sus riesgos y complicaciones. El objetivo del presente estudio fue describir y analizar variables quirúrgicas asocia-das a las extracciones unitarias de piezas dentarias. Los datos se analizaron mediante las pruebas Chi-cuadrado de Pearson, exacta de Fisher y Kruskal-Wallis, según lo que correspondía (p<0,05, signifi-cativo). Concurrieron más mujeres que hombres, con una mediana de edad de 37 años (intervalo, 18 a 86), siendo los terceros molares las piezas más ex-traídas. La pieza que requirió más odontosecciones fue el primer molar superior, mientras que la pieza que requirió más alveolectomías fue el tercer mo-lar inferior, siendo esta última la pieza con mayores complicaciones intra y post quirúrgicas, incluso una alteración nerviosa. La caries penetrante fue amplia-mente el motivo más frecuente de exodoncias (79%) superando los reportes en estudios similares, La du-ración promedio (DE) de las extracciones unitarias fue de 39 minutos (21), pero difirió significativamente entre piezas dentarias (p<0,05). Las complicaciones post quirúrgicas se asociaron significativamente a cirugías más prolongadas (p<0,05). La cantidad de anestubos utilizados también difirió significativa-mente entre piezas dentarias (p<0,05), siendo el sec-tor posterior inferior el que más cantidad necesitó. Los datos aportados en el estudio pueden ser utiliza-dos para mejorar recursos en los servicios de salud odontológicos (AU)

Dental extractions are the first procedures reported in dentistry, but few articles focus on its individual details. With proper information, educational and health policies could be systematically improved, and thus reduce risks and complications. The aim of the study was to describe and analyze surgical variables associated with single tooth extractions performed by students. The practice of 500 single extractions on 500 patients who attended the Oral and Maxillofacial service of the School of Dentistry of the University of Buenos Aires, between September 2021 and September 2022, performed by fourth-year students supervised by teachers, are described. Data were analyzed using Pearson's Chi-square, Fisher's exact or Kruskal-Wallis tests, as appropriate (p<0.05, significant). More women attended than men, with a median age of 37 years (range 18 to 86), with third molars being the most extracted pieces. Decay teeth was by far the most frequent reason for extractions (79%), exceeding reports in similar studies, that may be explained by a younger sample and the multiple extractions exclusion. The tooth that required the most sections was the upper first molar, while the tooth that required the most alveolectomies was the lower third molar, the latter being the tooth with the greatest intra- and post-surgical complications, including a reported nerve damage. The average duration (SD) of single extractions was 39 minutes (21), but it differed significantly between teeth (p<0.05), for example, upper central incisors presented an average of 21 (9), and upper first premolars 47 (25), characteristics not reported to date. As other studies reported, post-surgical complications were significantly associated with longer surgeries (p<0.05). The amount of anesthesia cartridges used also differed significantly between teeth (p<0.05), being the posterior mandible the one that needed the most amount. The data provided in the study can be systematically used to improve temporal and economic resources in dental health services (AU)

Spinal cord ischemia as intraoperatory complication in shoulder surgery positioned in beach chair: case report

Abstract Spinal cord infarction is an uncommon phenomenon, which can be caused by different etiologies, constituting a real diagnostic challenge which can lead to devastating consequences. General anesthesia in beach chair positioning with intraoperative hypotension in order to avoid surgical bleeding are associated with hypoperfusion and potential neurological ischemia-related complications. We present a case of spinal cord ischemia in the context of shoulder surgery in a beach chair position.

Role of temporary arterial occlusion in subarachnoid hemorrhage outcomes: a prospective cohort study

Purpose: Temporary arterial occlusion (TAO) is a widespread practice in the surgical treatment of intracranial aneurysms. This study aimed to investigate TAO's role during ruptured aneurysm clipping as an independent prognostic factor on short- and long-term outcomes. Methods: This prospective cohort included 180 patients with ruptured intracranial aneurysms and an indication of microsurgical treatment. Patients who died in the first 12 hours after admission were excluded. Results: TAO was associated with intraoperative rupture (IOR) (odds ratio ­ OR = 10.54; 95% confidence interval ­ 95%CI 4.72­23.55; p < 0.001) and surgical complications (OR = 2.14; 95%CI 1.11­4.07; p = 0.01). The group with TAO and IOR had no significant difference in clinical (p = 0.06) and surgical (p = 0.94) complications compared to the group that had TAO, but no IOR. Among the 111 patients followed six months after treatment, IOR, number of occlusions, and total time of occlusion were not associated with Glasgow Outcome Scale (GOS) in the follow-up (respectively, p = 0.18, p = 0.30, and p = 0.73). Among patients who underwent TAO, IOR was also not associated with GOS in the follow-up (p = 0.29). Conclusions: TAO was associated with IOR and surgical complications, being the latter independent of IOR occurrence. In long-term analysis, neither TAO nor IOR were associated with poor clinical outcomes.

Lesiones iatrogénicas del nervio radial en la osteosíntesis de la diáfisis humeral / Intraoperative iatrogenic injury of the radial nerve in humerus osteosynthesis

Introducción: Los objetivos de este estudio fueron determinar la incidencia de lesión iatrogénica intraquirúrgica del nervio radial durante la osteosíntesis de la diáfisis y el extremo distal del húmero, distinguir factores de riesgos asociados y reconocer elementos pronósticos que participan de su recuperación. Materiales y Métodos: Se evaluó, en forma retrospectiva, a 82 pacientes con osteosíntesis de húmero entre 2005 y 2021, sin parálisis radial preoperatoria. Se consideraron los sistemas de fijación utilizados, y se compararon las cirugías primarias con las reoperaciones y el tiempo transcurrido entre estas. El diagnóstico de parálisis radial posoperatorio fue clínico. Todos los pacientes fueron tratados con férula en extensión de muñeca, electroestimulación, kinesiología y vitaminas B1, B6, B12. La electromiografía se solicitó a los fines del pronóstico. Resultados: Nueve pacientes tuvieron déficit motor del nervio radial en el posoperatorio inmediato. El sistema de fijación era una placa (7 casos), sistema de cable-placa (1 caso) y clavo endomedular acerrojado anterógrado (1 caso). Siete ocurrieron en cirugías primarias y dos en reoperaciones. El 88% recuperó su función motora completamente antes de los 6 meses después de la parálisis. La electromiografía reveló un nervio radial no excitable en el 22% restante con parálisis definitiva. Conclusiones: El uso de placa de osteosíntesis, la disección intraoperatoria del nervio radial y las reoperaciones aumentan la incidencia de parálisis. Un nervio radial no excitable se relaciona con un peor pronóstico de recuperación espontánea. Nivel de Evidencia: IV

Introduction: The purpose of this study is to determine the incidence of intraoperative iatrogenic radial nerve injury after osteosynthesis of the diaphysis and distal end of the humerus, identify associated risk factors, and determine the prognostic factors involved in its recovery. Materials and Methods: We retrospectively assessed 82 humerus osteosynthesis cases between 2005 and 2021 who had normal radial nerve function before surgery. We evaluated the fixation systems used, the type of surgery (primary versus revision), and the intervals between surgeries. The diagnosis of postoperative radial palsy was made by clinical examination. All patients were treated with wrist extension splint, physiotherapy, and vitamins B1, B6, and B12. Results: After humerus fixation, 9 patients developed motor palsy. Seven cases were fixed with plates, one with a cable-plate system, and one with an anterograde locking intramedullary nail. Seven cases (22%) occurred after primary procedures, while two occurred during revisions. Within 6 months, 88% had regained full motor function. In the remaining 22% of patients with definite palsy, electromyography revealed no excitability of the radial nerve. Conclusions: The use of an osteosynthesis plate, as well as intraoperative dissection and neurolysis of the radial nerve, were identified as risk factors for the development of radial palsy. Reoperations on the humerus, on the other hand, are a risk factor that increases the likelihood of postoperative radial nerve palsy. A radial nerve with no excitability on the postoperative electromyogram has a poor prognosis of spontaneous radial nerve function recovery. Level of Evidence: IV

Complicaciones tempranas de la artroplastia total de cadera por vía anterolateral transglútea directa: estudio comparativo / Early complications in direct transgluteal anterolateral total hip arthroplasty. A comparative study

Introducción: En los últimos años, la introducción de diversas técnicas, el instrumental quirúrgico y las competencias del cirujano han contribuido a disminuir las complicaciones tempranas que pueden sobrevenir luego de una artroplastia de cadera. Las complicaciones más frecuentes son: el aflojamiento femoral, la trombosis venosa profunda y la luxación. Objetivos: Evaluar la tasa de complicaciones intraoperatorias y durante los primeros 12 meses luego de una artroplastia de cadera por vía anterolateral directa; y comparar los resultados con la serie publicada en 2007. Materiales y métodos: Estudio de cohorte retrospectivo que incluyó a pacientes operados por artrosis primaria de cadera en 2 instituciones, divididos en: grupo I (468 pacientes operados entre junio de 1999 y junio de 2003) y grupo II (344 pacientes operados entre enero de 2018 y enero de 2020). Resultados:La tasa global de complicaciones en la nueva serie fue del 4,7%. La trombosis venosa profunda fue la complicación que más se repitió, no hubo episodios de luxación. El empleo de cabezas de 22 mm de diámetro se asoció con un riesgo de luxación más alto que con cabezas más grandes (OR = 6,7; IC95% 1,2-78,2). Conclusiones: La artroplastia total de cadera con abordaje anterolateral transglúteo directo causó una baja tasa global de complicaciones dentro del primer año de la cirugía. Las complicaciones se redujeron casi a la mitad en las cirugías realizadas entre 2018 y 2020, con respecto a la serie anterior, fundamentalmente a expensas de la luxación. Nivel de Evidencia: IV

Introduction: In recent years, the advent of new procedures, surgical instruments, and surgeon skills has contributed to a reduction in the number of early complications that can arise after hip arthroplasty. Among the most frequent are femoral loosening, deep vein thrombosis, and dislocation. Objective: To evaluate the rate of intraoperative complications and complications within the first 12 months after a hip arthroplasty performed utilizing the direct anterolateral approach; and to compare the results to a series published in 2007. materials and methods: Retrospective cohort study, which included patients who underwent surgery for primary hip osteoarthritis at two institutions, divided into: group I (468 patients who were operated between June 1999 and June 2003) and group II (344 patients who were operated between January 2018 and January 2020). Results: The global rate of complications in group II was 4.7%. Deep vein thrombosis was the most frequent event, and there were no episodes of dislocation. The use of 22 mm diameter heads was associated with a higher risk of dislocation compared to surgeries in which larger heads were used (OR= 6.7 - 95% CI 1.2 - 78.2). Conclusions: Total hip replacement through a direct transgluteal anterolateral approach had a low global rate of complications within the first postoperative year. Complications were reduced by almost half in surgeries performed between 2018 and 2020, compared to the previous series, mainly in regards to dislocation. Level of Evidence: IV

Eventos adversos em pacientes cirúrgicos: incidência, características e fatores associados / Adverse events in surgical patients: incidence, characteristics and associated factors

Objetivo: Estimar a incidência de eventos adversos e identificar os fatores associados à sua ocorrência em pacientes cirúrgicos de um hospital geral de referência do interior de Minas Gerais, Brasil. Método: Estudo retrospectivo e documental realizado em 851 prontuários de pacientes submetidos a procedimentos cirúrgicos. Para rastrear e identificar o evento adverso, utilizou-se uma adaptação do método Global Trigger Tool, adotou-se a dupla revi-são dos documentos de forma independente e a análise de dados por estatística descritiva, teste χ2, t de Student e regressão logística. Resultados: Foram identificados 145 eventos adversos em 108 prontuários, mais da metade relacionada a complicações no local da cirurgia, como sangramento e infecções de sítio cirúrgico. O tempo de internação prolongado, a duração da cirurgia superior a quatro horas e procedimentos cirúrgicos classificados como con-taminados mostraram-se associados a maiores chances de ocorrência do evento adverso (p<0,001). Conclusão: Os eventos adversos na assistência cirúr-gica possuem elevada frequência e impacto de danos causados, reforçando a importância das estratégias voltadas para a segurança do paciente cirúrgico

Objective: To estimate the incidence of adverse events and identify the factors associated with their occurrence in surgical patients at a general reference hospital in the interior of Minas Gerais, Brazil. Method: Retrospective and documentary study carried out in 851 medical records of patients undergoing surgical procedures. To track and identify the adverse event, an adaptation of the Global Trigger Tool method was used, with double review of documents independently and data analysis using descriptive statistics, χ2 test, Student's t-test and logistic regression. Results: 145 adverse events were identified in 108 medical records, more than half related to complications at the surgical site, such as bleeding and surgical site infections. Prolonged hos-pital stay, duration of surgery longer than four hours and surgical procedures classified as contaminated were associated with greater chances of adverse event occurrence (p<0.001). Conclusion: Adverse events in surgical care have a high frequency and impact of damage caused, reinforcing the importance of strategies aimed at the safety of surgical patients

Objetivo: Estimar la incidencia de eventos adversos e identificar los factores asociados a su ocurrencia en pacientes quirúrgicos en un hospital general de referencia en el interior de Minas Gerais, Brasil. Método: Estudio retrospectivo y documental realizado en 851 historias clínicas de pacientes sometidos a procedimientos quirúrgicos. Para el seguimiento e identificación del evento adverso se utilizó una adaptación del método Global Trigger Tool. Se adoptó el procedimiento de doble revisión de documentos de forma independiente y el análisis de datos se realizó mediante estadística descriptiva, prueba de chi-cuadrado, prueba t de Student y regresión logística. Resultados: Se identificaron 145 eventos adversos en 108 historias clínicas. Más de la mitad se relacionaron con complicaciones en el sitio quirúrgico, como sangrado e infecciones del sitio quirúrgico. La estancia hospitalaria prolongada, la duración de la cirugía mayor a cuatro horas y la realización de procedimientos quirúrgicos clasificados como contaminados se asociaron con mayo-res posibilidades de ocurrencia de eventos adversos (p<0,001). Conclusión: Los eventos adversos en la atención quirúrgica tienen una alta frecuencia e impacto del daño causado, reforzando la importancia de las estrategias dirigidas a la seguridad de los pacientes quirúrgicos

Resultados del tratamiento quirúrgico del cáncer de recto y ano en el Hospital Español / Results of the surgical treatment of rectal and anal cancer in the Hospital Español / Resultados do tratamento cirúrgico do câncer de reto e ânus no Hospital Español

La cirugía del cáncer de recto y ano se ha desarrollado considerablemente en las últimas décadas. En función de dichos avances, se ha observado una disminución en la morbimortalidad operatoria, así como también una mejoría en el pronóstico de estos pacientes. El objetivo del presente estudio es exponer y analizar los resultados del tratamiento quirúrgico del cáncer de recto y ano en un servicio universitario. Se realizó un estudio observacional, descriptivo y retrospectivo de todos los pacientes intervenidos por cáncer de recto y ano en el Hospital Español entre 2016 y 2020. Las variables registradas fueron: variables demográficas, clínico-oncológicas, relacionadas a la morbimortalidad operatoria y a la recidiva locorregional, y la sobrevida a 5 años. El procedimiento más realizado fue la resección anterior de recto (RAR) en 11 intervenciones (58%), mientras que las 8 restantes correspondieron a amputaciones abdominoperineales (AAP) (42%). Se diagnosticaron un total de 6 complicaciones intraoperatorias en 5 pacientes, siendo la perforación del tumor la más frecuente, y un total de 18 complicaciones postoperatorias en 11 pacientes, siendo la más frecuente la infección de la herida quirúrgica abdominal. La morbilidad operatoria mayor fue de 31,6% y la mortalidad operatoria a 90 días fue de 0%. La sobrevida global a 5 años fue de 63,2%. Los resultados quirúrgicos en la presente casuística fueron comparables con los de la bibliografía consultada. Destacamos la nula mortalidad a 90 días, con resultados oncológicos similares a los reportados en la literatura.

Rectal and anus surgery have been developed considerably in the last decades. Based on these advancements, it has been observed a decrease in the surgical morbidity and mortality, as well as an improved prognosis of these patients. The aim of the present study is to expose and analyze the results of the anus and rectal surgical treatment in a university service. An observational, descriptive and retrospective study was performed of all the intervened patients for rectum and anus cancer in the Hospital Español between 2016 and 2020. We recorded data about demographic, clinical-oncologic, related to the surgical morbidity and mortality, locoregional relapse and overall 5 year survival. The most performed procedure was the rectum anterior resection in 11 interventions (58%), while the 8 left corresponded to abdominoperineal resection (42%). There was a total of 6 intraoperative complications diagnosed in 5 patients, being the tumor perforation the most frequent one, and a total of 18 postoperative complications diagnosed in 11 patients, being the surgical wound infection the most frequent one. The serious surgical morbidity was 31,6%, while the surgical mortality rate at 90 days was 0%. Overall 5 year survival was 63,2%. The surgical results in the present study about the rectum and anal cancer were comparable with the results reported on the consulted bibliography. We highlight the null mortality within 90 days, with oncologic results similar to the ones reported in the literature.

A cirurgia do câncer retal e anal desenvolveu-se consideravelmente nas últimas décadas. Com base nesses avanços, observou-se diminuição da morbimortalidade operatória, bem como melhora no prognóstico desses pacientes. O objetivo deste estudo é apresentar e analisar os resultados do tratamento cirúrgico do câncer de reto e anal em um serviço universitário. Foi realizado um estudo observacional, descritivo e retrospectivo de todos os pacientes operados por câncer de reto e ânus no Hospital Espanhol entre 2016 e 2020. As variáveis ​​registradas foram: variáveis ​​demográficas, clínico-oncológicas, relacionadas à morbidade e mortalidade operatórias e recorrência locorregional. , e sobrevida em 5 anos. O procedimento mais realizado foi a ressecção anterior do reto (RAR) em 11 intervenções (58%) e as 8 restantes corresponderam a amputações abdominoperineais (AAP) (42%). Foram diagnosticadas 6 complicações intraoperatórias em 5 pacientes, sendo a perfuração tumoral a mais frequente, e um total de 18 complicações pós-operatórias em 11 pacientes, sendo a infecção da ferida operatória abdominal a mais frequente. A morbidade operatória maior foi de 31,6% e a mortalidade operatória em 90 dias foi de 0%. A sobrevida global em 5 anos foi de 63,2%. Os resultados cirúrgicos da presente casuística foram comparáveis ​​aos da bibliografia consultada. Destacamos a mortalidade nula em 90 dias, com resultados oncológicos semelhantes aos relatados na literatura.

Prevalência das complicações em cirurgia de terceiros molares inferiores: um estudo transversal / Prevalencia de complicaciones en cirugía de terceros molares inferiores: un estudio transversal / Prevalence of Complications in Inferior Third Molar Surgery: A Cross-Sectional Study

Introdução: A extração de terceiros molares é um dos procedimentos mais comuns realizados pelos cirurgiões bucomaxilofaciais e as potenciais complicações dessa intervenção estão bem documentadas. Objetivo: O objetivo deste estudo é encontrar as associações entre essas complicações e variáveis relacionadas aos dentes ou aos pacientes e, assim, ajudar os cirurgiões a predizê-las e preveni-las. Métodos: Nosso estudo avalia a prevalência de omplicações em exodontias de terceiros molares inferiores utilizando uma amostra populacional brasileira em um período de 10 anos para estabelecer a probabilidade dessas complicações e sua associação com variáveis como idade, sexo e posição do dente na arcada . As mesmas variáveis foram usadas em relação a pericoronarite prévia. Trata-se de um estudo observacional retrospectivo transversal, seguindo as diretrizes STROBE. Resultados e Conclusões: Mil e nove pacientes tiveram 1.822 terceiros molares extraídos, sem associação detectada entre condições sistêmicas e complicações, embora esses pacientes com complicações sistêmicas tenham 1,9 vezes mais chances de ter pericoronarite. A pericoronarite foi mais prevalente em pacientes saudáveis, com classificação A e III de Pell & Gregory e posição distoangular. Esses achados corroboram a literatura atual ao comparar a classificação de Pell e Gregory e a maior prevalência de complicações... (AU)

Introducción: La extracción de terceros molares es uno de los procedimientos más comunes realizados por los cirujanos orales y maxilofaciales y las posibles complicaciones de esta intervención están bien documentadas. Objetivo: El objetivo de este estudio es encontrar las asociaciones entre estas complicaciones y variables relacionadas con dientes o pacientes y así ayudar a los cirujanos a predecirlas y prevenirlas. Métodos: Nuestro estudio evalúa la prevalencia de complicaciones en extracciones de terceros molares inferiores utilizando una muestra de población brasileña durante un período de 10 años para establecer la probabilidad de estas complicaciones y su asociación con variables como la edad, el sexo y la posición de los dientes en el arco. Las mismas variables se utilizaron para determinar pericoronitis previa. Se trata de un estudio observacional, transversal, retrospectivo, siguiendo las directrices STROBE. Resultados y Conclusiones: A mil nueve pacientes se les extrajeron 1.822 terceros molares, no detectándose asociación entre condiciones sistémicas y complicaciones, aunque estos pacientes tenían 1,9 veces más probabilidad de tener pericoronitis. La pericoronitis fue más prevalente en pacientes sanos, con clasificación A y III de Pell & Gregory y posición distoangular. Estos hallazgos corroboran la literatura actual al comparar la clasificación de Pell y Gregory y la mayor prevalencia de complicaciones... (AU)

Introduction: Extraction of third molars is one the most common procedures carried out by Oral and Maxillofacial Surgeons and the potential complications of such intervention are well documented. Purpose: The objective of this study is to find the associations between these complications and variables related either to the teeth or the patients and thus help surgeons to predict and prevent them. Methods: Our study evaluate the prevalence of complications in extractions of the lower third molars using a Brazilian population sample over a period of 10 years to establish the probability of these complications and their association with variables such as age, sex and tooth position in the arch. The same variables were used to determine previous pericoronitis. This is a retrospective cross-sectional observational study, following the STROBE guidelines. Results and Conclusions: One thousand and nine patients had 1,822 third molars extracted, with no associations detected between systemic conditions and complications, although these patients are 1.9 times more likely to have pericoronitis. Pericoronitis was more prevalent in healthy patients, with Pell & Gregory classification A and III and distoangular position. These findings corroborate the current literature when comparing Pell and Gregory classification and the higher prevalence of complications... (AU)