RESUMO
AIM: To compare under similar conditions intraoperative surgical efficiencies metrics between an active fluidics and a gravity based phacoemulsification systems. METHODS: Adult patients who were diagnosed with a cataract that compromised visual acuity inferior to 20/40 were included in the study. Patients were excluded from the study if they had a history of severe retinal disorders, clinically significant corneal endothelial dystrophy or history of corneal disease. All phacoemulsification surgeries were performed by a single surgeon. Both phacoemulsification systems used the 0.9 mm 45-degree aspiration bypass system Intrepid Balanced tip and the 0.9 mm Intrepid Ultra infusion sleeve. All cataracts were classified using the Lens Opacities Classification System III, cumulative dissipated energy (CDE) and aspiration fluids were measured in each surgery. RESULTS: Totally 2000 eyes were included in the study. Phacoemulsification was performed in 1000 (50%) eyes with an active fluid dynamics system and in 1000 (50%) eyes with a gravity-based fluidic system. Mean CDE until fracture of the lens was 1.1 and 1.9 percent-seconds and total mean CDE used was 5.6 and 7.2 percent-seconds using an active fluidics dynamics system and gravity-based fluidic system, respectively (P<0.001). Mean aspiration fluids used were 70 mL using an active fluidics dynamics system and 85 mL using a gravity-based fluidic system (P<0.001). CONCLUSION: This study evidences that surgeries performed under similar conditions (same surgeon, phaco tip and sleeve) with the active fluidics dynamics system required significantly lower CDE and aspiration fluids.
RESUMO
BACKGROUND: There are many high-volume trauma centers in limited resource environments where a thorough clinical examination of patients may contribute to a more economical, accurate, and widely applicable method of determining the proper management of patients with penetrating neck injuries. The purpose of this study was to validate thorough physical examination as a reliable diagnostic tool in these patients. METHODS: We performed an observational retrospective study of a diagnostic accuracy test where we compared clinical findings (symptoms and soft signs on admission of the patient) with the definitive findings according to the gold standard test for each particular situation (selective studies, clinical observation and surgical exploration). The study was conducted at Hospital Occidente Kennedy (HOK) between August 2009 and June 2010. RESULTS: The sample consisted of the clinical records of 207 (n = 207) patients who went to the emergency room for penetrating neck wounds at Hospital Occidente Kennedy (HOK). Of the total sample, 36.2% (n = 75) of patients were considered "asymptomatic" as they didn't present with any soft signs of injury. Vascular soft signs were present in 57% (n = 118) of the patients, soft signs of the airway and the upper gastrointestinal tract were present in 15.9% (n = 33) and 21.3% (n = 44) of the patients respectively. The sensitivity and negative predictive value (NPV) of any soft sign to determine injuries which require surgical repair was 97.4% [CI] [86.5-99.5%] and 98.7% [CI] [92.8-99.8%] respectively, with a range of confidence [CI] of 95%. CONCLUSIONS: Our study's main findings suggest that patients with neck injuries and no vascular, airway, or gastrointestinal soft sign can be safely managed with a conservative approach. It is important to emphasize the value of the clinical examination since there are many contexts in the modern world where a considerable amount of the population is afflicted by neck trauma and treated under conditions where technological resources are limited.
