Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation.

Background: The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns. Methods: Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated. Results: Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS. Conclusions: Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection.

Comparação dos resultados cirúrgicos da nefrolitotripsia percutânea entre as posições prona e valdivia-galdakao / Comparison of surgical results of percutaneous nephrolithotomy between prona and valdivia-galdakao positions

Introdução: O objetivo do estudo foi comparar os resultados cirúrgicos da nefrolitotripsia percutânea entre as posições prona e Valdivia-Galdakao. Métodos: Foi realizado estudo retrospectivo transversal com análise de dados de pacientes submetidos à NLPC em posição prona e Valdivia-Galdakao. Os pacientes foram subdivididos de acordo com os critérios da Classificação de Guy. Resultados: Foram analisados 136 pacientes (86 em posição prona e 50 em posição Valdivia-Galdakao). A média do tempo cirúrgico da posição prona foi de 161min e da posição Valdivia-Galdakao foi de 134min. A taxa de limpeza completa foi semelhante em ambas as posições, 40% em posição prona e 39,5% em posição Valdivia-Galdakao. Conclusões: O posicionamento cirúrgico em Valdivia-Galdakao apresentou tempo cirúrgico menor que o posicionamento prono, principalmente nos casos menos complexos (Guy's 1). A posição supina é uma opção segura e eficaz no tratamento de litíase renal e uma alternativa atraente em relação à sua variante clássica.

Introduction: The objective was to compare the surgical results of percutaneous nephrolithotomy between the prone and Valdivia-Galdakao positions. Methods: A retrospective cross-sectional study was performed with data analysis from patients submitted to PCNL. The patients were arranged in prone and Valdivia-Galdakao position. Patients were subdivided according to the Guy Classification criteria. Results: A total of 136 patients were analyzed (86 in prone position and 50 in Valdivia-Galdakao). The average surgical time in prone position was 161min and in Valdivia-Galdakao position was 134min. The complete clearing rate was similar in both positions, 40% in prone position and 39,5% in Valdivia-Galdakao position. Conclusions: The Valdivia-Galdakao positioning had less surgical time than prone positioning, especially in less complex cases (Guy's 1). The supine position is a safe and effective option in the treatment of renal lithiasis and an alternative to be considered regarding to the classical variant.

O real cirurgião de resgate: relatos de casos de um hospital universitário em Curitiba-PR-Brasil / The real rescue surgery: case reports from a university hospital in Curitiba-PR-Brazil

INTRODUÇÃO: A cirurgia de resgate á baseada em alguns pilares básicos: trauma, cirurgia de emergência, cuidados intensivos cirúrgicos, cuidados nutricionais, cirurgia geral eletiva, resgate cirúrgico e retirar a sepse do abdome. Este modelo de tratamento cirúrgico demonstrou maior eficiência, menor tempo de operação e menor tempo de internação hospitalar. Este artigo aborda dois casos clínicos em que o modelo de cirurgia de resgate foi usado como base para o tratamento. OBJETIVO: A ênfase deste caso é demonstrar que há uma necessidade de uma equipe de cirurgiões prontos para atuar com base nos cinco pilares da cirurgia de resgate para manejar pacientes gravemente feridos. METODOLOGIA: Esse estudo se caracteriza por ser um relato de casos, com análise de prontuário de maneira retrospectiva. CONCLUSÃO: É importante reconhecer que, embora não haja consenso entre as diretrizes para o tratamento de algumas morbidades agudas, cada paciente deve ser tratado individualmente para reduzir a mortalidade intra-hospitalar

INTRODUCTION: Rescue surgery is based on some basic pillars: trauma, emergency surgery, surgical intensive care, elective general surgery and surgical rescue. This model of surgical treatment demonstrated greater efficiency, shorter operating time and shorter hospital stay. This article approach two clinical cases in which the rescue surgery model was used as the basis for treatment. OBJECTIVE: The emphasis of this case is to demonstrate that there is a need for a team of surgeons ready to act based on the five pillars of rescue surgery to manage severely injured patients. METHODOLOGY: This study is characterized by being a case report, with retrospective analysis of medical records. CONCLUSION: It is important to recognize that, although there is no consensus between the guidelines for the treatment of some acute morbidities, each patient must be treated individually to reduce in-hospital mortality

Correlação entre anamnese e clínica na claudicação intermitente com auxílio de teste de esteira / Correlation between anamnesis and clinic in intermittent claudication with belt testing

INTRODUÇÃO: A doença arterial obstrutiva periférica afeta mais de 250 milhões de pessoas no mundo. Um terço relata ter claudicação intermitente, descrita como cãibra, dor ou cansaço iniciado durante a caminhada fazendo o paciente parar após percorrer uma determinada distância - descanso para retomar sua atividade. Além de prejudicar a qualidade de vida do paciente, é utilizada como critério para tratamento da e na maioria dos casos, avaliada através da anamnese. OBJETIVO: Identificar a correlação da percepção do paciente claudicante a respeito da sua caminhada e a realidade observada em uma avaliação em esteira. METODOLOGIA: Foi realizada uma anamnese inicial indagando a percepção do paciente sobre sua caminhada com posterior avaliação em esteira. As variáveis foram analisadas segundo distribuição Gausiana, teste Exato de Fisher e teste T Student. Através destes testes avaliamos as diferenças entre os resultados (anamnese versus caminhada na esteira) e valores de p menores do que 0.05 foram considerados significativos. RESULTADOS: Avaliamos 39 pacientes com doença arterial obstrutiva periférica e obtivemos uma média de 88,1% de diferença entre a anamnese e a caminhada na esteira. CONCLUSÃO: A avaliação da distância máxima percorrida do paciente com doença arterial obstrutiva periférica mostra-se inconsistente através da anamnese

BACKGROUND: Peripheral arterial obstructive disease affects more than 250 million people worldwide. Of these, one-third report having intermittent claudication, a symptom described as cramp, pain or tiredness initiated during the walk causing the patient to stop after walking a certain distance, and then a rest break is necessary to resume his activity. Intermittent claudication, in addition to impairing the patient's quality of life, is used as a criterion for the treatment of peripheral obstructive arterial disease and in the majority of cases, evaluated through anamnesis done with the patient. OBJECTIVE: To identify the correlation of the patient's claudicating perception regarding their walk and the reality observed in a treadmill evaluation. METHODS: An initial anamnesis was performed investigating the perception of the patient with intermittent claudication on their walk with subsequent evaluation of the same on a treadmill. The variables were analyzed according to Gaussian distribution, Fisher's exact test and Student's T test. Through these tests we evaluated the differences between the results (anamnesis versus treadmill walking) and p values of less than 0.05 were considered significant for this study. RESULTS: A total of 39 patients with peripheral arterial obstructive disease were evaluated, with a mean of 88.1% difference between anamnesis and treadmill walking. CONCLUSION: The evaluation of the maximum distance walked by the patient with PAD is inconsistent considering only the anamnesis