Assessing how emergency and trauma ultrasonography is taught to medical students.

OBJECTIVE: To evaluate a method aimed at teaching ultrasound techniques to medical students in emergency settings. METHODS: A prospective study conducted with 66 sixth-year undergraduate medical students. Students participated in theory and practicing sessions with a 5-hour load; knowledge acquisition was assessed through pre- and post-course and 90-day tests. A questionnaire were distributed to the students after course completion for theoretical and practical knowledge assessment. RESULTS: Average pre-test grade in theoretical content evaluation was 4.9, compared to 7.6 right after course completion, and 5.9 within 90 days (p<0.001). Questions addressing technical aspects and image acquisition were mostly answered correctly; in contrast, questions related to clinical management of patients tended to be answered incorrectly. In practical evaluation, 54 students (81.8%) were able to correctly interpret images. CONCLUSION: Ultrasound applicability and image acquisition techniques can be taught to medical students in emergency settings. However, teaching should be focused on technical aspects rather than clinical management of patients.

Assessing how emergency and trauma ultrasonography is taught to medical students / Avaliação do ensino de ultrassonografia em urgência e trauma para graduandos em Medicina

ABSTRACT Objective To evaluate a method aimed at teaching ultrasound techniques to medical students in emergency settings. Methods A prospective study conducted with 66 sixth-year undergraduate medical students. Students participated in theory and practicing sessions with a 5-hour load; knowledge acquisition was assessed through pre- and post-course and 90-day tests. A questionnaire were distributed to the students after course completion for theoretical and practical knowledge assessment. Results Average pre-test grade in theoretical content evaluation was 4.9, compared to 7.6 right after course completion, and 5.9 within 90 days (p<0.001). Questions addressing technical aspects and image acquisition were mostly answered correctly; in contrast, questions related to clinical management of patients tended to be answered incorrectly. In practical evaluation, 54 students (81.8%) were able to correctly interpret images. Conclusion Ultrasound applicability and image acquisition techniques can be taught to medical students in emergency settings. However, teaching should be focused on technical aspects rather than clinical management of patients.

RESUMO Objetivo Avaliar metodologia para o ensino de técnicas de ultrassom para estudantes de Medicina em ambiente de emergência. Métodos Estudo prospectivo realizado com 66 alunos do sexto ano de graduação em Medicina. Os alunos participaram de aulas teóricas e práticas com carga de 5 horas, e os conhecimentos adquiridos foram avaliados em provas antes, logo depois e 90 dias após o curso. Após a conclusão das aulas, foi distribuído um questionário aos alunos, tendo sido avaliados os conhecimentos teórico e prático. Resultados Nas avaliações teóricas, a média do grau de pré-teste foi de 4,9, com aumento observado para 7,6 após o término do curso, e de 5,9 para o teste de 90 dias (p<0,001). Questões sobre aspectos técnicos e aquisição de imagens foram mais frequentemente respondidas, e aquelas relacionadas ao manejo clínico foram as mais respondidas incorretamente. Na avaliação prática, 54 alunos (81,8%) conseguiram interpretar as imagens. Conclusão Foi possível ensinar o uso de técnicas de ultrassom em um ambiente de emergência para estudantes na faculdade de Medicina e instruí-los em técnicas de aquisição de imagens, mas a instrução deve se concentrar em aspectos técnicos, e não em gerenciamento clínico.

Basic ultrasound training assessment in the initial abdominal trauma screening.

OBJECTIVE: to verify the efficiency and usefulness of basic ultrasound training in trauma (FAST - Focused Assessment with Sonography in Trauma) for emergency physicians in the primary evaluation of abdominal trauma. METHODS: a longitudinal and observational study was carried out from 2015 to 2017, with 11 emergency physicians from Hospital Universitário do Oeste do Paraná, submitted to ultrasound training in emergency and trauma (USET® - SBAIT). FAST results started to be collected two months after the course. These were compared with a composite score of complementary exams and surgical findings. Information was stored in a Microsoft Excel program database and submitted to statistical analysis. RESULTS: FAST was performed in 120 patients. In the study, 38.4% of the assessed patients had a shock index ≥0.9. The composite score detected 40 patients with free peritoneal fluid, whereas FAST detected 27 cases. The method sensitivity was 67.5%, specificity was 98.7%, the positive predictive value was 96.4%, the negative predictive value was 85.39% and accuracy was 88%. All those with a positive FAST had a shock index ≥0.9. Fifteen patients with positive FAST and signs of instability were immediately submitted to surgery. CONCLUSIONS: the basic training of emergency physicians in FAST showed efficiency and usefulness in abdominal trauma assessment. Due to its low cost and easy implementation, this modality should be considered as a screening strategy for patients with abdominal trauma in health systems.

Basic ultrasound training assessment in the initial abdominal trauma screening / Avaliação de treinamento básico em ultrassom na triagem inicial do trauma abdominal

ABSTRACT Objective: to verify the efficiency and usefulness of basic ultrasound training in trauma (FAST - Focused Assessment with Sonography in Trauma) for emergency physicians in the primary evaluation of abdominal trauma. Methods: a longitudinal and observational study was carried out from 2015 to 2017, with 11 emergency physicians from Hospital Universitário do Oeste do Paraná, submitted to ultrasound training in emergency and trauma (USET® - SBAIT). FAST results started to be collected two months after the course. These were compared with a composite score of complementary exams and surgical findings. Information was stored in a Microsoft Excel program database and submitted to statistical analysis. Results: FAST was performed in 120 patients. In the study, 38.4% of the assessed patients had a shock index ≥0.9. The composite score detected 40 patients with free peritoneal fluid, whereas FAST detected 27 cases. The method sensitivity was 67.5%, specificity was 98.7%, the positive predictive value was 96.4%, the negative predictive value was 85.39% and accuracy was 88%. All those with a positive FAST had a shock index ≥0.9. Fifteen patients with positive FAST and signs of instability were immediately submitted to surgery. Conclusions: the basic training of emergency physicians in FAST showed efficiency and usefulness in abdominal trauma assessment. Due to its low cost and easy implementation, this modality should be considered as a screening strategy for patients with abdominal trauma in health systems.

RESUMO Objetivo: verificar a eficiência e a utilidade do treinamento básico em ultrassom no trauma (Focused Assessment with Sonography in Trauma - FAST) para emergencistas, na avaliação primária do trauma abdominal. Métodos: estudo longitudinal, observacional, realizado durante o período de 2015 a 2017, com 11 emergencistas do Hospital Universitário do Oeste do Paraná, submetidos ao treinamento em ultrassom na emergência e trauma (USET® - SBAIT). Resultados dos FAST começaram ser coletados dois meses após o curso. Estes foram comparados com escore composto de exames complementares e achados cirúrgicos. Informações foram armazenadas em banco de dados do programa Microsoft Excel® e submetidas à análise estatística. Resultados: foram realizados FAST em 120 pacientes. No estudo, 38,4% dos pacientes avaliados apresentavam índice de choque ≥0,9. O escore composto detectou 40 pacientes com líquido livre peritoneal. FAST detectou 27 casos de líquido livre peritoneal. A sensibilidade do método foi de 67,5%, a especificidade de 98,7%, o valor preditivo positivo de 96,4%, o valor preditivo negativo de 85,39% e a acurácia foi de 88%. Todos que tiveram FAST positivo apresentavam índice de choque ≥0,9. Quinze pacientes com FAST positivo e sinais de instabilidade foram conduzidos imediatamente para cirurgia. Conclusões: o treinamento básico de emergencistas em FAST demonstrou eficiência e utilidade na avaliação do trauma abdominal. Por seu baixo custo e facilidade de implantação, esta modalidade deve ser considerada como estratégia de triagem de pacientes com trauma abdominal nos sistemas de saúde.

Comparative study of abdominal cavity temporary closure techniques for damage control / Estudo comparativo de técnicas de fechamento temporário da cavidade abdominal durante o controle de danos

ABSTRACT The damage control surgery, with emphasis on laparostomy, usually results in shrinkage of the aponeurosis and loss of the ability to close the abdominal wall, leading to the formation of ventral incisional hernias. Currently, various techniques offer greater chances of closing the abdominal cavity with less tension. Thus, this study aims to evaluate three temporary closure techniques of the abdominal cavity: the Vacuum-Assisted Closure Therapy - VAC, the Bogotá Bag and the Vacuum-pack. We conducted a systematic review of the literature, selecting 28 articles published in the last 20 years. The techniques of the bag Bogotá and Vacuum-pack had the advantage of easy access to the material in most centers and low cost, contrary to VAC, which, besides presenting high cost, is not available in most hospitals. On the other hand, the VAC technique was more effective in reducing stress at the edges of lesions, removing stagnant fluids and waste, in addition to acting at the cellular level by increasing proliferation and cell division rates, and showed the highest rates of primary closure of the abdominal cavity.

RESUMO A cirurgia de controle de danos, com ênfase em peritoneostomia, geralmente resulta em retração da aponeurose e perda da capacidade de fechar a parede abdominal, levando à formação de hérnias ventrais incisionais. Atualmente, várias técnicas oferecem maiores chances de fechamento da cavidade abdominal, com menor tensão. Deste modo, este estudo tem por objetivo avaliar três técnicas de fechamento temporário da cavidade abdominal: fechamento a vácuo (Vacuum-Assisted Closure Therapy - VAC), Bolsa de Bogotá e Vacuum-pack. Realizou-se uma revisão sistemática da literatura com seleção de 28 artigos publicados nos últimos 20 anos. As técnicas de Bolsa de Bogotá e Vacuum-pack tiveram como vantagem o acesso fácil ao material, na maioria dos centros, e baixo custo, ao contrário do que se observa na terapia a vácuo, VAC, que além de apresentar alto custo, não está disponível em grande parte dos hospitais. A técnica VAC, por outro lado, foi mais eficaz na redução da tensão nas bordas das lesões, ao remover fluidos estagnados e detritos, além de exercer ação a nível celular, aumentando as taxas de proliferação e divisão celular, e apresentou as maiores taxas de fechamento primário da cavidade abdominal.

Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?

AIM: To compare the 3 main techniques of temporary closure of the abdominal cavity, vacuum assisted closure (vacuum-assisted closure therapy - VAC), Bogota bag and Barker technique, in damage control surgery. METHODS: After systematic review of the literature, 33 articles were selected to compare the efficiency of the three procedures. Criteria such as cost, infections, capacity of reconstruction of the abdominal wall, diseases associated with the technique, among others were analyzed. RESULTS: The Bogota bag and Barker techniques present as advantage the availability of material and low cost, what is not observed in the VAC procedure. The VAC technique is the most efficient, not only because it reduces the tension on the boarders of the lesion, but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division. Bogota bag presents the higher rates of skin laceration and evisceration, greater need for a stent for draining fluids and wash-ups, higher rates of intestinal adhesion to the abdominal wall. The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing. The VAC dressing can generate irritation and dermatitis when the drape is applied, in addition to pain, infection and bleeding, as well as toxic shock syndrome, anaerobic sepsis and thrombosis. CONCLUSION: The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity.

LIVER TRANSPLANTATION AFTER SEVERE HEPATIC TRAUMA: CURRENT INDICATIONS AND RESULTS / TRANSPLANTE DE FÍGADO APÓS TRAUMA HEPÁTICO GRAVE: INDICAÇÕES ATUAIS E RESULTADOS

Background : The liver is the most injured organ in abdominal trauma. Currently, the treatment in most cases is non-operative, but surgery may be necessary in severe abdominal trauma with blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesaving last resource Aim : Analyze the use of liver transplantation as a treatment option for severe liver trauma. Methods : Were reviewed 14 articles in the PubMed, Medline and Lilacs databases, selected between 2008-2014 and 10 for this study. Results : Were identified 46 cases undergoing liver transplant after liver trauma; the main trauma mechanism was closed/blunt abdominal trauma in 83%, and severe trauma (>grade IV) in 81 %. The transplant can be done, in this context, performing one-stage procedure (damaged organ removed with immediate transplantation), used in 72% of cases. When the two-stage approach is performed, end-to-side temporary portacaval shunt is provided, until new organ becomes available to be transplanted. If two different periods are considered - from 1980 to 2000 and from 2000 to 2014 - the survival rate increased significantly, from 48% to 76%, while the mortality decreased from 52% to 24%. Conclusion : Despite with quite restricted indications, liver transplantation in hepatic injury is a therapeutic modality viable and feasible today, and can be used in cases when other therapeutic modalities in short and long term, do not provide the patient survival chances.

Introdução : O fígado é um dos órgãos mais afetados nos traumas abdominais. Atualmente, o tratamento de escolha na maioria dos casos é o não operatório; porém, a intervenção cirúrgica pode ser necessária nos traumas abdominais severos com lesão hepática grave, principalmente naqueles que provocam hemorragias de difícil controle. Apesar das abordagens de controle de danos visando a estabilidade hemodinâmica, muitos pacientes evoluem para choque hipovolêmico, insuficiência hepática aguda, falência múltipla de órgãos e óbito. Nesse contexto, o transplante hepático surge como última opção de tratamento. Objetivo : Analisar a utilização do transplante hepático como modalidade terapêutica em traumas hepáticos graves. Método : Foram revisados 14 artigos obtidos nas bases de dados Pubmed, Medline e Lilacs entre 2008-2014, sendo selecionados 10 para o presente estudo. Resultados : Foram identificados 46 relatos de casos de pacientes submetidos à transplante de fígado após trauma hepático; o principal mecanismo de trauma foi o fechado/contuso com 83%, e traumas graves (>grau IV) em 81%. O transplante pôde ser realizado em uma etapa (paciente com órgão lesado removido e imediatamente recebia o enxerto), utilizado em 72% dos casos. Nos procedimentos em duas etapas realizava-se shunt temporário portocava até que um órgão fosse disponibilizado. Na análise de dois períodos distintos - 1980 a 2000 e 2000 a 2014 -, taxa de sobrevida aumentou significativamente, passando de 48% para 76% e a mortalidade caiu de 52% para 24%. Conclusão : O transplante hepático apesar de ter indicações bastante restritas no cenário do trauma hepático, representa modalidade terapêutica nos dias de hoje viável e factível, podendo ser empregada em casos onde o tratamento cirúrgico, assim como outras modalidades terapêuticas, não ofereçam ao paciente chances de sobrevida a curto e longo prazo.

LIVER TRANSPLANTATION AFTER SEVERE HEPATIC TRAUMA: CURRENT INDICATIONS AND RESULTS.

BACKGROUND: The liver is the most injured organ in abdominal trauma. Currently, the treatment in most cases is non-operative, but surgery may be necessary in severe abdominal trauma with blunt liver damage, especially those that cause uncontrollable bleeding. Despite the damage control approaches in order to achieve hemodynamic stability, many patients develop hypovolemic shock, acute liver failure, multiple organ failure and death. In this context, liver transplantation appears as the lifesaving last resource Aim : Analyze the use of liver transplantation as a treatment option for severe liver trauma. METHODS: Were reviewed 14 articles in the PubMed, Medline and Lilacs databases, selected between 2008-2014 and 10 for this study. RESULTS: Were identified 46 cases undergoing liver transplant after liver trauma; the main trauma mechanism was closed/blunt abdominal trauma in 83%, and severe trauma (>grade IV) in 81 %. The transplant can be done, in this context, performing one-stage procedure (damaged organ removed with immediate transplantation), used in 72% of cases. When the two-stage approach is performed, end-to-side temporary portacaval shunt is provided, until new organ becomes available to be transplanted. If two different periods are considered - from 1980 to 2000 and from 2000 to 2014 - the survival rate increased significantly, from 48% to 76%, while the mortality decreased from 52% to 24%. CONCLUSION: Despite with quite restricted indications, liver transplantation in hepatic injury is a therapeutic modality viable and feasible today, and can be used in cases when other therapeutic modalities in short and long term, do not provide the patient survival chances.

Is there a role for pyloric exclusion after severe duodenal trauma?

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.

Is there a role for pyloric exclusion after severe duodenal trauma? / Existe lugar para a exclusão pilórica no trauma duodenal grave?

Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.

O trauma duodenal é incomum, mas possui alta morbimortalidade. As condições clínicas dos pacientes, gravidade das lesões, tempo de diagnóstico e lesões associadas influenciam na escolha do procedimento operatório. A maioria das lesões duodenais é tratada com reparo primário. Procedimentos adjuvantes para proteger a linha de sutura e evitar deiscência podem ser úteis em lesões complexas. Embora a exclusão pilórica (EP) seja utilizada em lesões duodenais graves, há controvérsia quanto a sua necessidade. A reunião "Telemedicina Baseada em Evidências - Cirurgia do Trauma e Emergência" (TBE-CiTE) revisou a literatura e selecionou três publicações relevantes sobre as indicações de EP no trauma duodenal. O primeiro estudo, retrospectivo, comparou 14 pacientes com ferimentos penetrantes duodenais grau > II, tratados com EP, com 15 pacientes semelhantes tratados com reparo primário; não houve diferença nos resultados. O segundo, também retrospectivo, comparou o reparo primário (34 casos) com EP (16 casos), em lesões duodenais contusas ou penetrantes grau > II. Os autores concluíram que a EP não é necessária para todos os pacientes, apesar de lesões duodenais graves. O terceiro estudo constituiu-se de revisão da literatura sobre os desafios do tratamento dos traumatismos duodenais. Na experiência do autor, a EP é útil nos casos de fístula de anastomoses gastrojejunais. Conclui-se que a escolha do procedimento operatório no tratamento das lesões duodenais deve ser individualizada. Não há evidência cientifica de boa qualidade para justificar o abandono da EP no tratamento das lesões duodenais graves com grande perda tecidual.

Nonoperative management of splenic injury grade IV is safe using rigid protocol.

OBJECTIVE: To demonstrate the protocol and experience of our service in the nonoperative management (NOM) of grade IV blunt splenic injuries. METHODS: This is a retrospective study based on trauma registry of a university hospital between 1990-2010. Charts of all patients with splenic injury were reviewed and patients with grade IV lesions treated nonoperatively were included in the study. RESULTS: ninety-four patients with grade IV blunt splenic injury were admitted during this period. Twenty-six (27.6%) met the inclusion criteria for NOM. The average systolic blood pressure on admission was 113.07 ± 22.22 mmHg, RTS 7.66 ± 0.49 and ISS 18.34 ± 3.90. Ten patients (38.5%) required blood transfusion, with a mean of 1.92 ± 1.77 packed red cells per patient. Associated abdominal injuries were present in two patients (7.7%). NOM failed in two patients (7.7%), operated on due to worsening of abdominal pain and hypovolemic shock. No patient developed complications related to the spleen and there were no deaths in this series. Average length of hospital stay was 7.12 ± 1.98 days. CONCLUSION: Nonoperative treatment of grade IV splenic injuries in blunt abdominal trauma is safe when a rigid protocol is followed.

Tratamento não operatório de lesão esplênica grau IV é seguro usando-se rígido protocolo / Nonoperative management of splenic injury grade IV is safe using rigid protocol

OBJETIVO: demonstrar o protocolo e a experiência do serviço no TNO de lesões esplênicas contusas grau IV (classificação da Associação Americana de Cirurgia do Trauma). MÉTODOS: estudo retrospectivo baseado em registro de trauma de hospital universitário no período de 1990 a 2010. Prontuários de todos os pacientes com lesão esplênica foram revisados e os doentes tratados de modo não operatório com lesão grau IV foram incluídos no estudo. RESULTADOS: noventa e quatro pacientes com lesão esplênica contusa grau IV foram admitidos neste período. Vinte e seis (27,6%) apresentaram os critérios para o TNO. A média de pressão arterial sistólica na admissão foi de 113,07 ± 22,22mmHg, RTS = 7,66 ± 0,49 e ISS = 18,34 ± 3,90. Dez pacientes (38,5%) necessitaram de transfusão sanguínea, com uma média de 1,92 ± 1,77 concentrado de hemácias por paciente. Lesões abdominais associadas estavam presentes em dois pacientes (7,7%). O TNO falhou em dois pacientes (7,7%), operados devido à piora da dor abdominal e choque hipovolêmico. Nenhum paciente desenvolveu complicações relativas ao baço e não houve óbito na presente casuística. A média de dias de internação foi 7,12 ± 1,98 dias. CONCLUSÃO: o tratamento não operatório de lesões esplênicas grau IV no trauma abdominal contuso é seguro seguindo-se rígido protocolo.

OBJECTIVE: To demonstrate the protocol and experience of our service in the nonoperative management (NOM) of grade IV blunt splenic injuries. METHODS: This is a retrospective study based on trauma registry of a university hospital between 1990-2010. Charts of all patients with splenic injury were reviewed and patients with grade IV lesions treated nonoperatively were included in the study. RESULTS: ninety-four patients with grade IV blunt splenic injury were admitted during this period. Twenty-six (27.6%) met the inclusion criteria for NOM. The average systolic blood pressure on admission was 113.07 ± 22.22 mmHg, RTS 7.66 ± 0.49 and ISS 18.34 ± 3.90. Ten patients (38.5%) required blood transfusion, with a mean of 1.92 ± 1.77 packed red cells per patient. Associated abdominal injuries were present in two patients (7.7%). NOM failed in two patients (7.7%), operated on due to worsening of abdominal pain and hypovolemic shock. No patient developed complications related to the spleen and there were no deaths in this series. Average length of hospital stay was 7.12 ± 1.98 days. CONCLUSION: Nonoperative treatment of grade IV splenic injuries in blunt abdominal trauma is safe when a rigid protocol is followed.

[Prognostic factors of penetrating neck trauma]. / Fatores prognósticos nos ferimentos cervicais penetrantes.

UNLABELLED: The neck is vulnerable to trauma because of vital structures and possible major injuries with high morbidity and mortality rates. AIM: To evaluate the outcome in patients with penetrating cervical wounds. METHODS: The medical registries of 39 patients were analyzed retrospectively from 2001 to 2009. Penetrating wounds were defined as injuries that penetrated beyond the platysma muscle. Age, gender, etiology, wound site, injured structures, treatment, and outcome were analyzed. Fisher's exact test was adopted to establish the link between these variables and the outcome (discharge or death). RESULTS: Of 39 patients, 33 (84.62%) were men with a mean age of 28 years. The main cause was firearm projectiles - 19 (48.72%) cases; the most frequently affected zone was zone II - 29 (74.36%). Thirteen (33.3%) cases of hemodynamic instability were observed, and the average hospital stay was 14 (1-99) days. The main indication for surgical intervention was the presence of profuse hemorrhage, in eight (20.5%) cases. The main structures affected were the cervical veins (20.5%). There were eight (20.51%) deaths. Younger patients had a better prognosis. CONCLUSION: The mortality rate was 20.51%. Patients below age 26 years had a better prognosis.

Fatores prognósticos nos ferimentos cervicais penetrantes / Prognostic factors of penetrating neck trauma

O pescoço é vulnerável a traumatismos devido à grande quantidade de estruturas vitais, podendo ocorrer lesões importantes e com alta morbimortalidade. OBJETIVO: Avaliar resultados em pacientes vítimas de ferimentos penetrantes cervicais. MÉTODOS: Foram analisados retrospectivamente prontuários de 39 pacientes entre 2001 e 2009. Ferimentos penetrantes foram definidos como lesões que penetravam além do músculo platisma. Foram analisados idade, gênero, etiologia, localização dos ferimentos, estruturas lesadas, tratamento e desfecho. Foi verificada a associação entre essas variáveis e o desfecho (alta ou óbito) por meio do teste exato de Fisher. RESULTADOS: Dos 39 pacientes analisados, 33 (84,62 por cento) eram homens, com média de 28 anos. A principal causa de ferimento cervical penetrante foi projétil de arma de fogo, com 19 (48,72 por cento) casos e a zona mais acometida foi a zona II, com 29 (74,36 por cento). Foram observados 13 (33,3 por cento) casos de instabilidade hemodinâmica e o tempo médio de internação dos pacientes foi de 14 (1-99) dias. A principal indicação da exploração cirúrgica foi a presença de hemorragia profusa em oito (20,5 por cento) dos casos. As principais estruturas acometidas foram veias cervicais (20,5 por cento). Ocorreram oito (20,51 por cento) óbitos. Pacientes jovens apresentaram melhor prognóstico. CONCLUSÃO: A mortalidade foi de 20,51 por cento. Pacientes com menos de 26 anos apresentaram melhor prognóstico.

The neck is vulnerable to trauma because of vital structures and possible major injuries with high morbidity and mortality rates. AIM: To evaluate the outcome in patients with penetrating cervical wounds. METHODS: The medical registries of 39 patients were analyzed retrospectively from 2001 to 2009. Penetrating wounds were defined as injuries that penetrated beyond the platysma muscle. Age, gender, etiology, wound site, injured structures, treatment, and outcome were analyzed. Fisher's exact test was adopted to establish the link between these variables and the outcome (discharge or death). RESULTS: Of 39 patients, 33 (84.62 percent) were men with a mean age of 28 years. The main cause was firearm projectiles - 19 (48.72 percent) cases; the most frequently affected zone was zone II - 29 (74.36 percent). Thirteen (33.3 percent) cases of hemodynamic instability were observed, and the average hospital stay was 14 (1-99) days. The main indication for surgical intervention was the presence of profuse hemorrhage, in eight (20.5 percent) cases. The main structures affected were the cervical veins (20.5 percent). There were eight (20.51 percent) deaths. Younger patients had a better prognosis. CONCLUSION: The mortality rate was 20.51 percent. Patients below age 26 years had a better prognosis.

Ferimentos cervicais penetrantes

Introdução: o pescoço é uma região vulnerável a traumatismos devido à grande quantidade de estruturas vitais em um espaço pequeno, podendo ocorrer lesões importantes e com alta morbimortalidade.

Ferimentos cervicais penetrantes / Penetrating neck injuries

Introdução: o pescoço é uma região vulnerável a traumatismos devido à grande quantidade de estruturas vitais em um espaço pequeno, podendo ocorrer lesões importantes e com alta morbimortalidade. (AU)

Ferimentos cervicais penetrantes / Penetrating neck injuries

Introdução: o pescoço é uma região vulnerável a traumatismos devido à grande quantidade de estruturas vitais em um espaço pequeno, podendo ocorrer lesões importantes e com alta morbimortalidade.

Resultados da laringectomia horizontal supraglótica / Supraglottic horizontal laryngectomy outcome

Introdução: O câncer supraglótico pode ser removido por meio da laringectomia horizontal supraglótica (LHSG), obtendo-se bons resultados oncológicos e funcionais. Objetivo: Avaliar os resultados em um grupo de pacientes consecutivos submetidos à LHSG. Métodos: Entre 1997 e 2007, 13 pacientes tratados por carcinoma espinocelular (CEC) de supraglote e base de língua por meio da LHSG foram retrospectivamente estudados. Resultados: Houve oito pacientes estadiados como T2 e cinco como T3. Dentre eles, três pacientes apresentavam pescoço clinicamente negativos. Todos os pacientes foram submetidos à LHSG. Em oito pacientes, realizou-se esvaziamento cervical bilateral e, em quatro, esvaziamento cervical radical ipsilateral e jugular contralateral. Radioterapia adjuvante foi feita em todos os pacientes. O seguimento variou de 12 a 60 meses. A sobrevida específica para a doença e o controle loco-regional a cinco anos foram de 69,2%. Todos os pacientes obtiveram resultados funcionais próximos ao normal após o tratamento. Uma mediana de 16 dias (7-60) foi necessária para a aquisição de uma dieta próxima do normal. A decanulação levou uma mediana de 17 dias (8-65). Não houve caso de aspiração persistente. Não houve traqueostomia permanente nem laringectomia total por razões funcionais. Conclusão: A LHSG permanece sendo uma alternativa terapêutica adequada para o CEC supraglótico. O restabelecimento de boa função laríngea é a regra.

Introduction: Supraglottic cancer can be removed by horizontal supraglottic laryngectomy (HSGL) obtaining good oncological and functional outcome. Objective: To evaluate the outcome in a group of consecutive patients undergoing HSGL. Methods: Between 1997 and 2007, 13 patients treated for supraglottic and base of the tongue squamous cell carcinoma (SCC) with HSGL were retrospectively studied. Results: There were 8 patients with T2 and 5 with T3 tumors. Among these, 3 patients had clinical negative neck disease. All patients underwent HSGL. Eight patients were submitted to bilateral radical neck dissection, whereas 4 patients were submitted to ipsilateral radical and contralateral lateral neck dissection. Adjuvant radiotherapy was given to all patients. The follow up ranged from 12 to 60 months. Five-year disease-specific survival and locoregional control were 69.2%. All patients recovered a close to normal function after the treatment. A median of 16 days (7-60) was necessary to recover a close to normal diet. Decannulation took a median of 17 days (8-65). There was no persistent aspiration. There was no permanent tracheostomy or total laryngectomy for functional purposes. Conclusion: HSGL remains an adequate therapeutic alternative for supraglottic SCC. Good laryngeal function recovery is the rule.