Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter.

Thyroid surgery is the primary treatment for substernal goiters, and iatrogenic injury to the recurrent laryngeal nerve (RNL) is always a risk. The literature suggests that iatrogenic lesions of the RNL post resection of substernal goiter are not equally distributed, being more frequent on the right recurrent laryngeal nerve (R-RLN) in comparison to the left recurrent laryngeal nerve (L-RLN). The relative paucity of basic anatomical and clinical reportages on R-RLN iatrogenic injuries and on the developmental factors that may help explain its higher incidence justifies this study's undertaking. Here we compare incidence of right versus left iatrogenic injuries to the RLN in surgical resections of substernal goiters and discuss the anatomical and embryological factors involved. This report is part of a larger retrospective observational cohort study of 239 patients surgically treated for substernal goiter in the Gaffrée and Guinle University Hospital, Rio de Janeiro, from 2006 to 2018. From 239 patients, 13 presented with iatrogenic RLN injury, one patient presented bilateral lesion, totalling 15 iatrogenic lesions. Our analysis showed that the R-RLN seems to be anatomically more vulnerable to injury due to the embryological underpinnings addressed in this review, R-RLN = 64.29% (n = 9) and L-RLN = 35.71% (n = 5). Pathological factors like malignancy and size of the mass are relevant issues to be considered. The knowledge of anatomical landmarks and embryological development of the thyroid and associated structures can improve our understanding and teaching of surgical anatomy, thus helping prevent and reduce the number of iatrogenic injuries on right RLNs.

Surgical Management of Symptomatic Lumbar, Sacral, and Lumbosacral Plexus Tumors: a Peripheral Nerve Unit Experience.

OBJECTIVE: Data concerning the surgical treatment of lumbosacral plexus tumors (LSPTs) is scarce. This study aims to present our experience with a series of 19 patients surgically treated for symptomatic LSPTs at our institution. METHODS: This is a retrospective study of 19 patients surgically treated for symptomatic LSPTs from 2011 to 2019. Clinical data were retrieved from medical records and consisted of age, gender, clinical presentation, location of the lesion, surgical approach, final histopathologic diagnosis, follow-up time, outcomes, and complications. RESULTS: Nineteen surgical procedures were conducted. Thirteen patients were female and six, male. The median age of patients was 45 years (range 20 to 63 years). No patients harbored genetic syndromes. Surgical treatment appears to be correlated to the reduction of pain in patients with peripheral nerve sheath tumors (PNSTs), as assessed by visual analog scale (VAS). Sixteen patients did not present with new-onset deficits during follow-up (84.2%), two of whom recovered from their preoperative deficit. Four patients presented with postoperative weakness. The histopathological diagnoses were 11 schwannomas, four neurofibromas, three metastases, and one lymphoma. CONCLUSIONS: LSPTs are rare. When surgical treatment is indicated, it usually requires multidisciplinary management. Surgery appears to be effective concerning the reduction of pain in PNSTs and may also recover neurological deficits. Iatrogenic neurological deficits are an evident risk, such that intraoperative multimodal monitoring should always be performed if available. In lesions involving the sacral plexus, we found it to be indispensable.

PROTOCOLS FOR DIAGNOSIS AND MANAGEMENT OF INTRA-ABDOMINAL HYPERTENSION IN INTENSIVE CARE UNITS. / PROTOCOLOS PARA DIAGNÓSTICO E MANEJO DA HIPERTENSÃO INTRA-ABDOMINAL EM CENTROS DE TRATAMENTO INTENSIVO.

OBJECTIVES: Intra-abdominal hypertension (IAH) is a common morbid condition in critically ill patients. Abdominal compartment syndrome (ACS) is a severe condition that requires surgical treatment, and it is an evolution of undiagnosed and untreated IAH. This study aims to highlight the importance of clinical evidence, and proposes screening as well as medical protocols for IAH and ACS, in intensive care units. METHODS: Database searches were performed and the recommended World Society of the Abdominal Compartment Syndrome standards and protocols were used. RESULTS: Protocols for IAH and ACS investigation, measurements, management and control, tailored for the Brazilian ICU reality, were indicated. CONCLUSION: We extensively detailed IAH medical evidence, using the most up-to-date literature about IAH care and how to measure intra-abdominal pressure (IAP), which can be easily reproduced in any intensive care unit.

OBJETIVO: A hipertensão intra-abdominal (HIA) é uma condição mórbida comum em pacientes críticos. A síndrome compartimental abdominal (SCA) é condição grave de tratamento cirúrgico que ocorre como evolução da HIA não diagnosticada e não tratada. O objetivo deste trabalho é disseminar evidências e propor protocolos de rastreio e condutas em casos de HIA e SCA para centros de terapia intensiva (CTI). MÉTODOS: Foram realizadas buscas sobre o tema nas principais bases de dados e utilizadas as evidências e protocolos recomendadas pela World Society of the Abdominal Compartment Syndrome. RESULTADOS: Apresentamos protocolos sobre investigação, aferição, manejo e controle da HIA, adequadas à realidade brasileira. CONCLUSÃO: Neste trabalho, apresentamos em detalhes os principais fatos e evidências sobre o manejo em casos de suspeita de HIA e como aferir a pressão intra-abdominal (PIA), de forma simples e reproduzível para qualquer CTI do nosso país.

Protocolos para diagnóstico e manejo da hipertensão intra-abdominal em centros de tratamento intensivo / Protocols for diagnosis and management of intra-abdominal hypertension in intensive care units

RESUMO Objetivo: A hipertensão intra-abdominal (HIA) é uma condição mórbida comum em pacientes críticos. A síndrome compartimental abdominal (SCA) é condição grave de tratamento cirúrgico que ocorre como evolução da HIA não diagnosticada e não tratada. O objetivo deste trabalho é disseminar evidências e propor protocolos de rastreio e condutas em casos de HIA e SCA para centros de terapia intensiva (CTI) Métodos: Foram realizadas buscas sobre o tema nas principais bases de dados e utilizadas as evidências e protocolos recomendadas pela World Society of the Abdominal Compartment Syndrome. Resultados: Apresentamos protocolos sobre investigação, aferição, manejo e controle da HIA, adequadas à realidade brasileira. Conclusão: Neste trabalho, apresentamos em detalhes os principais fatos e evidências sobre o manejo em casos de suspeita de HIA e como aferir a pressão intra-abdominal (PIA), de forma simples e reproduzível para qualquer CTI do nosso país.

ABSTRACT Objectives: Intra-abdominal hypertension (IAH) is a common morbid condition in critically ill patients. Abdominal compartment syndrome (ACS) is a severe condition that requires surgical treatment, and it is an evolution of undiagnosed and untreated IAH. This study aims to highlight the importance of clinical evidence, and proposes screening as well as medical protocols for IAH and ACS, in intensive care units. Methods: Database searches were performed and the recommended World Society of the Abdominal Compartment Syndrome standards and protocols were used. Results: Protocols for IAH and ACS investigation, measurements, management and control, tailored for the Brazilian ICU reality, were indicated. Conclusion: We extensively detailed IAH medical evidence, using the most up-to-date literature about IAH care and how to measure intra-abdominal pressure (IAP), which can be easily reproduced in any intensive care unit.

A técnica de Baroudi-Ferreira reduz o seroma pós-abdominoplastia? / Does the Baroudi-Ferreira technique reduce seroma after abdominoplasty?

Introdução: A cirurgia plástica, em relação à abdominoplastia, evoluiu ao longo dos anos com o aprimoramento de técnicas que inicialmente apresentavam grandes índices de complicações. Porém, mesmo com a evolução das técnicas operatórias, a incidência de seroma pós-operatório se mantém como a complicação precoce mais frequente neste procedimento. O objetivo deste estudo é comparar a ocorrência de seroma em abdominoplastia com e sem a utilização de pontos de adesão. Métodos: Foram avaliadas 20 pacientes submetidas à abdominoplastia sendo distribuídas em dois grupos: Grupo A (abdominoplastia com utilização de pontos de adesão - Técnica de Baroudi-Ferreira) e Grupo B (abdominoplastia sem utilização de pontos de adesão). Resultados: No Grupo A houve seroma em 2 pacientes (20%), sendo significativamente menor (p = 0,05) do que no Grupo B, no qual foi diagnosticado em 7 pacientes (70%). A média de volume observada no Grupo A foi de 26,5 ml enquanto no Grupo B foi de 146,5 ml. O maior volume aspirado em pacientes do Grupo A foi 130 ml observado no 15º dia pós-operatório (DPO), ao passo que no Grupo B foi de 230 ml no 21º DPO. Conclusão: A ocorrência de seroma em abdominoplastia neste estudo foi significativamente menor no grupo em que foi utilizada a Técnica de Baroudi-Ferreira.

Introduction: Abdominoplasty has evolved over the years with improvement of techniques that initially had high complication rates. However, even with the evolution of operative techniques, seroma remains the most frequent early complication of this procedure. This study aims to compare the development of seroma after abdominoplasty with and without the use of quilting sutures. Methods: Twenty patients undergoing abdominoplasty were evaluated and divided into two groups: Group A (abdominoplasty using quilting sutures - Baroudi- Ferreira technique) and Group B (abdominoplasty without the use of quilting sutures). Results: Two patients in Group A (20%) had seroma, which was significantly lower (p = 0.05) than that in Group B, in which seven patients were diagnosed with seroma (70%). The mean volume observed in Group A was 26.5 mL, whereas in Group B, it was 146.5 mL. The highest volume aspirated in Group A was 130 mL, on the 15th postoperative day (POD), whereas in Group B it was 230 mL, on the 21st POD. Conclusion: In this study, the development of seroma in abdominoplasty was significantly lower in the group in which the Baroudi-Ferreira technique was used.

Linfoma primário da próstata / Primary lymphoma of prostate

É apresentado um caso de linfoma primitivo da próstata com quadro clínico de hiperplasia nodular da próstata. É discutida a evoluçäo da doença, a qual teve repercussöes para glândula salivar submandibular e posterior comprimetimento do retroperitônio e do parênquima hepático

Complicaçöes pós-operatórias imediatas das tireoidectomias / Immediate postoperative complications of thyroidectomies

Os autores focalizam pesquisa realizada com 183 pacientes operados de tireoidectomia, visando à determinaçäo das principais complicaçöes ocorridas no pós-operatório imediato e suas conseqüencias, destacando também as medidas preventivas e terapêuticas