Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach.

OBJECTIVE: to assess the impact of the shift inlet trauma patients, who underwent surgery, in-hospital mortality. METHODS: a retrospective observational cohort study from November 2011 to March 2012, with data collected through electronic medical records. The following variables were statistically analyzed: age, gender, city of origin, marital status, admission to the risk classification (based on the Manchester Protocol), degree of contamination, time / admission round, admission day and hospital outcome. RESULTS: during the study period, 563 patients injured victims underwent surgery, with a mean age of 35.5 years (± 20.7), 422 (75%) were male, with 276 (49.9%) received in the night shift and 205 (36.4%) on weekends. Patients admitted at night and on weekends had higher mortality [19 (6.9%) vs. 6 (2.2%), p=0.014, and 11 (5.4%) vs. 14 (3.9%), p=0.014, respectively]. In the multivariate analysis, independent predictors of mortality were the night admission (OR 3.15), the red risk classification (OR 4.87), and age (OR 1.17). CONCLUSION: the admission of night shift and weekend patients was associated with more severe and presented higher mortality rate. Admission to the night shift was an independent factor of surgical mortality in trauma patients, along with the red risk classification and age.

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach / Admissão noturna é fator de risco independente para mortalidade em pacientes vítimas de trauma - uma abordagem ao erro sistêmico

ABSTRACTObjective:to assess the impact of the shift inlet trauma patients, who underwent surgery, in-hospital mortality.Methods:a retrospective observational cohort study from November 2011 to March 2012, with data collected through electronic medical records. The following variables were statistically analyzed: age, gender, city of origin, marital status, admission to the risk classification (based on the Manchester Protocol), degree of contamination, time / admission round, admission day and hospital outcome.Results:during the study period, 563 patients injured victims underwent surgery, with a mean age of 35.5 years (± 20.7), 422 (75%) were male, with 276 (49.9%) received in the night shift and 205 (36.4%) on weekends. Patients admitted at night and on weekends had higher mortality [19 (6.9%) vs. 6 (2.2%), p=0.014, and 11 (5.4%) vs. 14 (3.9%), p=0.014, respectively]. In the multivariate analysis, independent predictors of mortality were the night admission (OR 3.15), the red risk classification (OR 4.87), and age (OR 1.17).Conclusion:the admission of night shift and weekend patients was associated with more severe and presented higher mortality rate. Admission to the night shift was an independent factor of surgical mortality in trauma patients, along with the red risk classification and age.

RESUMOObjetivo:verificar o impacto do turno de admissão de pacientes vítimas de trauma, submetidos ao tratamento cirúrgico, na mortalidade hospitalar.Métodos:estudo de coorte observacional retrospectivo no período de novembro de 2011 a março de 2012, com dados coletados através de prontuário eletrônico. Foram analisadas estatisticamente as variáveis de interesse: idade, sexo, cidade de origem, estado civil, classificação de risco à admissão (baseado no Protocolo de Manchester), grau de contaminação, horário/turno de admissão, dia de admissão e desfecho hospitalar.Resultados: Quinhentos e sessenta e três pacientes traumatizados foram submetidos ao tratamento cirúrgico no período estudado, com média de idade de 35,5 anos (± 20,7), sendo 75% do sexo masculino, 49,9% admitidos no turno noturno e 36,4% aos finais de semana. Os pacientes admitidos à noite e aos finais de semana apresentaram maior mortalidade, 6,9% vs. 2,2%, p=0,014, e 5,4% vs. 3,9%, p=0,014, respectivamente. À análise multivariada, os fatores preditores independentes de mortalidade foram a admissão noturna (OR 3,15), a classificação de risco vermelho (OR 4,87), e a idade (OR 1,17).Conclusão:a admissão no turno noturno e no final de semana foi associada com pacientes de maior gravidade e apresentaram maior taxa de mortalidade. A admissão no turno noturno foi fator independente de mortalidade em pacientes traumatizados cirúrgicos, juntamente com a classificação de risco vermelho e a idade.

Pulmonary effects after partial liver ischemia and reperfusion: experimental model.

OBJECTIVE: To describe an experimental model of hepatic ischemia/reperfusion injury with systemic manifestations, represented by pulmonary involvement, which may be used by those who intend to comprehend this phenomenon. METHODS: Fourteen Male Wistar rats (200-250g) were allocated to two groups, G1 with eight rats submitted only to laparotomy and G2, six rats submitted to hepatic ischemia and reperfusion. Hepatic (serum aminotransferases, mitochondrial respiration, histology) and pulmonary (Evans blue test) functions were analyzed. RESULTS: There was a statistically significant difference (p< 0.05) between G1 and G2 comparing values of AST (24,3 ± 108 and 5406 ± 2263), ALT (88,5 ± 28,5 and 5169 ± 2690), respiratory control ratio (3,41 ± 0,17 and 1,91 ± 0,55) and ADP/O relation (1,93 ± 0,03 and 1,45 ± 0,27), histological lesions (necrosis, inflammatory cells, hemorrhage, microsteatosis) and Evans blue test (194,31 ± 53 and 491,8 ± 141). CONCLUSION: The model has proven useful to study hepatic I/R injury.

Repercussões pulmonares após isquemia hepática parcial e reperfusão: modelo experimental / Pulmonary effects after partial liver ischemia and reperfusion: experimental model

OBJETIVO: Descrever um modelo experimental de lesão de isquemia/reperfusão hepática com manifestações sistêmicas, representadas pelo envolvimento pulmonar, que possa ser utilizado por aqueles que pretendem compreender esse fenômeno. MÉTODOS: Ratos Wistar machos (200-250g) foram usados. Quatorze foram alocados em dois grupos, sendo G1 com oito submetidos somente à laparotomia e G2, seis à isquemia e reperfusão hepática. As funções hepática (aminotransferases séricas, respiração mitocondrial, histologia) e pulmonar (teste do azul de Evans) foram analisadas. RESULTADOS: houve diferença estatística significativa entre G1 e G2 ao se comparar valores de AST (24,3 ± 108 e 5406 ± 2263), ALT (88,5 ± 28,5 e 5169 ± 2690), razão de controle respiratório (3,41 ± 0,17 e 1,91 ± 0,55) e relação ADP/O (1,93 ± 0,03 e 1,45 ± 0,27), lesões histológicas (necrose, células inflamatórias, hemorragia, microesteatose) e teste do azul de Evans (194,31 ± 53 e 491,8 ± 141). CONCLUSÃO: O modelo mostrou-se útil para o estudo de lesão de isquemia/reperfusão hepática.

OBJECTIVE: To describe an experimental model of hepatic ischemia/reperfusion injury with systemic manifestations, represented by pulmonary involvement, which may be used by those who intend to comprehend this phenomenon. METHODS: Fourteen Male Wistar rats (200-250g) were allocated to two groups, G1 with eight rats submitted only to laparotomy and G2, six rats submitted to hepatic ischemia and reperfusion. Hepatic (serum aminotransferases, mitochondrial respiration, histology) and pulmonary (Evans blue test) functions were analyzed. RESULTS: There was a statistically significant difference (p< 0.05) between G1 and G2 comparing values of AST (24,3 ± 108 and 5406 ± 2263), ALT (88,5 ± 28,5 and 5169 ± 2690), respiratory control ratio (3,41 ± 0,17 and 1,91 ± 0,55) and ADP/O relation (1,93 ± 0,03 and 1,45 ± 0,27), histological lesions (necrosis, inflammatory cells, hemorrhage, microsteatosis) and Evans blue test (194,31 ± 53 and 491,8 ± 141). CONCLUSION: The model has proven useful to study hepatic I/R injury.

[Protective effects of an inhibitor of glycoprotein IIb/IIIa in the hepatic and pulmonary disturbances secondary to ischemia and reperfusion injury of rat's liver]. / Efeito protetor de antagonista das gliproteínas IIb/IIa nas alterações hepáticas e pulmonares secundárias à isquemia e reperfusão do fígado em ratos.

UNLABELLED: BACKGROUND Hepatic ischemia-reperfusion injury is responsible for a considerable morbidity and mortality. AIM: To evaluate the effect of a platelet glycoprotein IIb/IIIa receptor inhibitor (tirofiban) on hepatic and pulmonary disturbances associated with hepatic ischemia-reperfusion injury. METHODS: Twenty-three Wistar rats divided in three groups: rats sham-operated (n = 6), rats submitted to ischemia-reperfusion that received saline solution (n = 8), and rats submitted to ischemia-reperfusion treated with 0.7 mg/kg of tirofiban (n = 9). Serum aminotransferases (AST and ALT) were also determined, and the study of hepatic tissue histology was carried out. The evaluation of the pulmonary disturbances was done using the Evans blue test and the tissular determination of myeloperoxidase. Hepatic mitochondrial oxidation and phosphorylation were also measured. RESULTS: There was an increase in the state 3 respiration, ADP/O ratio and respiration control rate in the group treated with tirofiban. This group had also lower levels of aminotransferases and the histological findings were significantly less intense. Pulmonary evaluation demonstrated decrease of the Evans blue test in the tirofiban group and an increase of its tissular determination of myeloperoxidase. CONCLUSION: The inhibition of glycoprotein IIb/IIIa receptor with tirofiban protected the hepatic disturbances and prevented the increase of pulmonary vascular permeability secondary to the ischemia-reperfusion injury of the liver.

Efeito protetor de antagonista das gliproteínas IIb/IIa nas alterações hepáticas e pulmonares secundárias à isquemia e reperfusão do fígado em ratos / Protective effects of an inhibitor of glycoprotein IIb/IIIa in the hepatic and pulmonary disturbances secondary to ischemia and reperfusion injury of rat’s liver

RACIONAL: A lesão de isquemia e reperfusão hepática é um evento comum e responsável por considerável morbidade e mortalidade. OBJETIVO: Avaliar efeitos de inibidor da glicoproteína IIb/IIIa, cloridrato de tirofiban, nas alterações hepáticas e pulmonares da lesão de isquemia e reperfusão de fígado de ratos. MÉTODO: Vinte e três ratos Wistar divididos em três grupos: laparotomia (n = 6), isquemia e reperfusão que receberam solução fisiológica (n = 8), e submetidos a isquemia e reperfusão e tratados com o cloridrato de tirofiban (n = 9). Foram realizadas dosagens das aminotransferases e análise histológica hepática. Avaliação pulmonar foi realizada pelo teste do azul de Evans e pela dosagem tecidual da mieloperoxidase no parênquima pulmonar. A oxidação e fosforilação mitocondrial das células hepáticas também foram avaliadas. RESULTADOS: O grupo tratado com cloridrato de tirofiban apresentou menores níveis de aminotransferases, assim como alterações histológicas menos intensas. Avaliação pulmonar demonstrou diminuição no teste de azul de Evans no grupo tratado com cloridrato de tirofiban. Grupo tratado com cloridrato de tirofiban apresentou aumento significativo do estado 3 da respiração mitocondrial e das relações adenosina difosfato utilizado para fosforilação sobre o oxigênio consumido na reação e de coeficiente respiratório. CONCLUSÕES: O uso do cloridrato de tirofiban exerceu papel protetor da lesão hepática de isquemia e reperfusão e impediu o aumento da permeabilidade vascular secundária à lesão de reperfusão hepática.

BACKGROUND Hepatic ischemia-reperfusion injury is responsible for a considerable morbidity and mortality. Aim - To evaluate the effect of a platelet glycoprotein IIb/IIIa receptor inhibitor (tirofiban) on hepatic and pulmonary disturbances associated with hepatic ischemia-reperfusion injury. METHODS: Twenty-three Wistar rats divided in three groups: rats sham-operated (n = 6), rats submitted to ischemia-reperfusion that received saline solution (n = 8), and rats submitted to ischemia-reperfusion treated with 0.7 mg/kg of tirofiban (n = 9). Serum aminotransferases (AST and ALT) were also determined, and the study of hepatic tissue histology was carried out. The evaluation of the pulmonary disturbances was done using the Evans blue test and the tissular determination of myeloperoxidase. Hepatic mitochondrial oxidation and phosphorylation were also measured. RESULTS: There was an increase in the state 3 respiration, ADP/O ratio and respiration control rate in the group treated with tirofiban. This group had also lower levels of aminotransferases and the histological findings were significantly less intense. Pulmonary evaluation demonstrated decrease of the Evans blue test in the tirofiban group and an increase of its tissular determination of myeloperoxidase. CONCLUSION: The inhibition of glycoprotein IIb/IIIa receptor with tirofiban protected the hepatic disturbances and prevented the increase of pulmonary vascular permeability secondary to the ischemia-reperfusion injury of the liver.

Unusual case of pentastomiasis mimicking liver tumor.

Pentastomiasis is a rare zoonotic disease. Almost all recorded cases of human pentastomiasis had been incidental findings at autopsy. We report an unusual case of human pentastomiasis mimicking liver tumor successfully treated by liver resection. This clinical presentation is uncommon and it was probably caused by a pentastomid that exited its cyst and migrated to the liver causing an infarct that was mistaken as a primary liver tumor. Diagnosis could not be made before the surgery. This is the first reported case of human pentastomiasis in Brazil.

Strategies to treat primary unresectable colorectal liver metastases.

The liver is the most common site of metastases in patients with colorectal cancer (CRC), and hepatic metastases are responsible for fatalities in at least two thirds of patients with colorectal malignancy. However, the only available treatment associated with long-term survival in patients with CRC metastases is liver resection. While recent studies have shown that liver resection achieves a 5-year overall survival from 37% to 58%, only 10% to 20% of patients with colorectal liver metastases are eligible for resection. Pharmacologic developments and conceptual advances in chemotherapy, regional treatment, and aggressive surgical strategies have ultimately changed the current treatment of patients with primary unresectable liver metastases caused by CRC. Patients who were treated by only palliative chemotherapy a few years ago presently have a variety of strategies available to render their disease surgically resectable with the potential for long-term survival. These advances are the result of a strong collaboration between medical oncologists and surgeons. The development of new chemotherapy protocols that offer the potential for curative surgery with optimum timing within the natural history of this metastatic disease is a shared therapeutic challenge.

[Laparoscopic distal pancreatectomy for pancreatic cystadenomas]. / Pancreatectomia distal videolaparoscópica em pacientes com cistadenoma de pâncreas.

BACKGROUND: Cystic neoplasms are an uncommon group among pancreatic tumors. These lesions are seen more frequently in recent surgical practice, probably because of advances in diagnostic and surgical techniques. Total tumor resection provides the best chance of cure and may remove the risk of malignant transformation of the cystadenomas, particularly of the mucinous type. Minimally invasive techniques have been revolutionary and provide clinical evidence of decreased morbidity and comparable efficacy to traditional, open surgery. However, laparoscopic pancreatic resection is not an established treatment for tumors of the pancreas. AIM: The authors present their initial experience with laparoscopic distal pancreatectomy for pancreatic cystadenomas. MATERIAL AND METHODS: Three female patients (mean age, 55 years) underwent laparoscopic pancreatic resection between September 2001 and December 2003. RESULTS: Laparoscopic pancreatic resection was successfully performed in all patients. Operative time varied between 4 and 6 hours. Intraoperative bleeding was minimal. Due to a thick pancreas, the application of vascular endoscopic stapler was difficult in one patient. Two patients presented postoperative pancreatic leakage with spontaneous resolution. CONCLUSIONS: Resection of the pancreas can be safely performed via the laparoscopic approach with all the potential benefits to the patients of minimally invasive surgery.

Pancreatectomia distal videolaparoscópica em pacientes com cistadenoma de pâncreas / Laparoscopic distal pancreatectomy for pancreatic cystadenomas

RACIONAL: O diagnóstico de tumores císticos do pâncreas vem aumentando nos últimos anos. Estes tumores acometem geralmente pacientes do sexo feminino e apresentam poucos sintomas. Sua remoção por videolaparoscopia está indicada em pacientes selecionadas, principalmente quando localizados na região distal do pâncreas. OBJETIVOS: É apresentada a experiência inicial de um grupo de cirurgiões na realização de pancreatectomia distal por videolaparoscopia em pacientes com cistadenoma pancreático. MATERIAL E MÉTODOS: Três pacientes do sexo feminino (idade média, 55 anos) foram submetidas a ressecção pancreática por videolaparoscopia entre setembro de 2001 e dezembro de 2003. RESULTADOS: A ressecção pancreática por videolaparoscopia foi realizada com sucesso nas três doentes. O tempo cirúrgico variou de 4 a 6 horas. O sangramento operatório foi mínimo em todos os casos. A aplicação do grampeador endoscópico foi difícil em uma paciente devido à espessura do pâncreas. As três pacientes evoluíram bem, recebendo alta entre o 2° e o 5° dia pós-operatório. Duas apresentaram fístula pancreática com resolução após tratamento conservador. CONCLUSÃO: A pancreatectomia laparoscópica é factível, pode trazer benefícios aos pacientes portadores de neoplasia cística da porção distal do pâncreas, com pouca dor pós-operatória, curto tempo de permanência hospitalar, baixo índice de complicações e melhor resultado estético.

Efeito de antagonista das glicoproteínas IIb/IIIa nas alterações hepáticas e pulmonares secundárias à isquemia e reperfusão de fígado em ratos / Effects of an inhibitor of glycoprotein IIb/IIIa in the hepatic aaand pulmonary disturbances secondary to ischemia and reperfusion injury of rat's liver

A lesão de isquemia e reperfusão é um fator de morbidade importante na cirurgia hepática. O estudo avaliou os efeitos do uso de antagonista das glicoproteínas IIb/IIIa nas alterações hepáticas e pulmonares secundárias à lesão de isquemia e reperfusão de fígado em ratos. Foram analisadas as determinações teciduais da mieloperoxidase e do teste do Azul de Evans no parênquima pulmonar, além de os níveis séricos das transaminases, da respiração mitocondrial e da histologia hepática. O antagonista das glicoproteínas IIb/IIIa apresentou efeito protetor das alterações hepáticas e impediu o aumento da permeabilidade vascular pulmonar secundárias à lesão de isquemia e reperfusão de fígado / schemia-reperfusion injury is a determinant of successful liver surgery. This study evaluates the effect of platelet glycoprotein IIb/IIIa receptor inhibition on hepatic and pulmonary disturbances associated with ischemia-reperfusion injury of the liver in rats. The determination of myeloperoxidase and Evan’s blue test of pulmonary parenquima, moreover the measure of serum transaminases, the evaluation of the mitochondrial respiration and histology of liver tissue were carried out. The inhibition of glycoprotein IIb/IIIa receptor protected the hepatic disturbances and prevented the increase of pulmonary vascular permeability secondary to the ischemia-reperfusion injury of the liver...

Laparoscopic resection of gastric duplication: successful treatment of a rare entity.

Alimentary tract duplications are rare congenital malformations that may be found anywhere from mouth to anus. They usually share a common smooth muscle wall and blood supply with the adjacent bowel. Some duplications are asymptomatic but most cause problems in early childhood. Gastric duplications account for 2% to 7% of all gastrointestinal duplications. The management of gastric duplication is essentially surgical. The treatment of choice is the complete excision of the gastric duplication without violation of the gastric lumen whenever possible. The authors report an unusual case of gastroesophageal junction duplication completely removed by laparoscopy. To our knowledge, this is the first case of gastric duplication successfully treated by laparoscopy in English literature. Laparoscopic resection may be added to the surgical armamentarium in the treatment of alimentary tract duplications.