Mesenteric Infarction With Cerebral Thrombotic Relapses and Pulmonary Embolism Two and Four Months After COVID-19.

The aim of the present study was to report different sites of thrombotic events during and after coronavirus disease 2019 (COVID-19) in a 49-year-old patient who had acute mesenteric infarction in acute phase, stroke 2 months after and pulmonary thromboembolism 4 months after infection by COVID-19. The obese, previously healthy patient experienced myalgia and headache with subfebrile peaks and was tested positive for COVID-19 with a fast polymerase chain reaction (PCR) assay. Ten days after the onset of symptoms, the patient was submitted to exploratory laparotomy, which revealed 20 cm of small intestine loop with signs of suffering and thickening of the wall approximately 120 cm from the ileocecal valve. Two months after the event, angiotomography was performed, revealing effacement of the sulci in the right parietal region and hypersignal of the right middle cerebral artery with stop in M1. Two months later (4 months after the mesenteric infarction), chest angiotomography revealed signs of acute pulmonary thromboembolism, with no typical image of pulmonary infarction. Despite all these complications in the postoperative period, the patient survived.

Mortality of Patients Infected by COVID-19 with and without Deep-Vein Thrombosis.

BACKGROUND: Current evidence points to a state of hypercoagulability (consequence of hyperinflammation) as an important pathogenic mechanism that contributes to the increase in mortality in cases of COVID-19. The aim of the present study was to investigate the influence of deep-vein thrombosis on mortality patient's infected with SARS-CoV-2. METHOD: A clinical trial was conducted involving 200 consecutive patients with COVID-19-100 patients who were positive for deep-vein thrombosis (venous Doppler ultrasound) and 100 who were negative for deep-vein thrombosis at a public hospital. RESULTS: The mortality rate was 67% in the group positive for DVT and 31% in the group negative for DVT. CONCLUSION: Deep-vein thrombosis is associated with an increase in mortality in patients with COVID-19 and failures can occur with conventional prophylaxis for deep-vein thrombosis.

Improving Intraoperative Communication in Trauma: The Educational Effect of the Joint DSTC™-DATC™ Courses.

BACKGROUND: Operative management of severe trauma requires excellent communication among team members. The surgeon and anesthesiologist need to interact efficiently, exchanging vital information. The Definitive Surgical Trauma Care (DSTC) and Definitive Anesthesia Trauma Care (DATC) courses provide an excellent opportunity for teamwork training. Our goal was to study the impact of the joint DSTC-DATC courses in candidates' self-reported assessment in communication skills and techniques in a simulated intraoperative trauma scenario. METHODS: Study population consists of 93 candidates (67 surgeons and 26 anesthesiologists) participating in four consecutive joint DSTC-DATC courses in May and June 2019 in Brazil (3) and in Portugal (1). Median age was 30 years; 53 (60%) of subjects were male (46 senior residents and 47 specialists). All participants attended joint lectures, case discussions and surgical skills session, emphasizing intraoperative communication. Post-course survey on several aspects of perioperative communication (responses on a Likert scale) was conducted with participants being asked which aspects of intraoperative communication they valued the most. RESULTS: All participants responded to the survey. Results displayed an increase in the self-assessed importance of team briefing and intraoperative communication, particularly routine periodic communication, rather than only at critical moments. Postoperative team debriefing was also valued as highly relevant. Closed-loop and direct, by-name communication were highly rated. Self-reported communication skills improved significantly during the course. CONCLUSIONS: Joint training in the DSTC-DATC courses improved candidates' perception and skills on proficient intraoperative communication. Further studies should address both the durability of these changes and the potential impact on patient care.

Motociclistas acidentados: caracterização, perfil comportamental e sintomas de transtornos mentais / Crashed motorcycle riders: characterization, behavioral profile, and mental disorders symptoms

Introdução: Acidentes de trânsito (AT) são uma das principais causas de trauma no mundo. No Brasil, a taxa de mortalidade de motociclistas envolvidos em AT aumentou de forma significante entre 2004 e 2014: de 2,8 para 6,2 óbitos respectivamente por 100 mil habitantes. Objetivos: caracterizar o perfil sociodemográfico e clínico de motociclistas vítimas de Acidentes de Trânsito atendidos no Hospital de Base de São José do Rio Preto (2016 a 2018); identificar o perfil comportamental desses pacientes e rastrear sintomas de transtornos mentais. Métodos: pacientes envolvidos em acidentes com motocicleta (motoristas), atendidos no Pronto Atendimento da Cirurgia do Hospital de Base de São José do Rio Preto, SP, Brasil, foram convidados a participar do estudo e responderam aos seguintes instrumentos: Mini International Neuropsychiatric Interview (MINI) e Inventário de Auto-Avaliação para Adultos (ASR). O Banco de Dados da Unidade de Trauma do Hospital de Base forneceu as infomações do prontuário para a construção do perfil sociodemográfico e clínico (referentes às lesões do trauma) do paciente. Resultados: Os participantes (n = 40) eram principalmente do sexo masculino, com média de idade de 33,83 anos (± 12,95) e baixa escolaridade; 13 relataram dirigir após ingestão de bebida alcoólica. A maioria apresentou lesões leves. Foram identificados (ASR e MINI) problemas externalizantes e internalizantes, violação de regras, queixas somáticas, abuso de álcool e de crack. Conclusão: Entre os motociclistas acidentados houve predominância de jovens do sexo masculino com baixa escolaridade, maior prevalência de lesões nas extremidades e no abdomem, uso de álcool associado à direção e presença de sintomas de transtornos mentais internalizantes e externalizantes.

Introduction: Motorcycle accidents are the main causes of trauma in the world. In Brazil, death rates of motorcyclists involved in traffic accidents have increased significantly from 2004 to 2014, going from 2.8 to 6.2 deaths per 100 thousand inhabitants. Objectives: To characterize the sociodemographic and clinical profile of traffic accidents victims involved in motorcycle accidents referred to Hospital de Base, São José do Rio Preto, S.P., Brazil, from 2016 to 2018; To identify the behavioral profile of these patients, and trace symptoms of mental disorders. Methods: Patients involved in a motorcycle accident (riders) who received medical attention at the emergency surgery service at Hospital de Base were invited to participate the study. All participants signed the informed consent form. We used the following instruments: Mini International Neuropsychiatric Interview (MINI) and the Adult Self-Assessment Inventory (ASAI). Patients' files were retrieved from the Trauma Unit registries in order to build a sociodemographic and clinical profile of the patient, as well as any medical information. Results: We included 40 participants, mainly men with a mean of age 33.83±12.95 years and lower scholar degree; 13 participants reported driving after drinking alcohol. Most had mild injuries. Externalizing and internalizing problems, infringement of rules, somatic complaints, as well as alcohol and crack abuse were identified. Conclusion: Among crashed motorcycle riders, there was a predominance of young men with low education and higher prevalence of injuries to the extremities and abdomen. We also concluded that the participants presented the use of alcohol associated with motorcycle riding, as well as the presence of symptoms of internalizing and externalizing mental disorders.

Mortality in patients with loss of consciousness at the scene of trauma.

BACKGROUND AND AIM: The aim of this study was to evaluate if loss of consciousness at the scene of an accident in patients with thoracic trauma classified by the Abbreviated Injury Scale (AIS) as thorax >2 has a different outcome in respect to immediate hospital discharge, hospitalization, death and type of accident. METHODS: A prospective study was performed in the Regional Trauma Center of São José do Rio Preto. All patients with scores related to thoracic injury >/=2 were included in this study. Thus, 134 patients with penetrating and 231 with blunt thoracic injuries were evaluated. The chi-square, Fisher's exact and relative risk tests were utilized for statistical analysis with an alpha error greater than 5% (p < 0.05) being considered statistically significant. RESULTS: A significantly higher number of patients who lost consciousness (35-33.9%) died compared to those who did not lose consciousness (9-3.5%, Fisher's exact test: p < 0.0001) where the relative risk (RR) of death when an individual lost consciousness was 9.7 (95% CI: 4.8-19.4). In respect to the necessity of hospital treatment, those who lost consciousness were more commonly hospitalized (Fisher's exact test: p < 0.0001). CONCLUSION: The loss of consciousness at the time of trauma is a warning sign in patients with thoracic injuries whether associated with other types of injuries or not.

Prevalence of death due to pulmonary embolism after trauma.

BACKGROUND: Pulmonary thromboembolism is an important cause of death affecting thousands of people worldwide. The current study aims to evaluate the prevalence of death due to pulmonary embolism after trauma. MATERIALS AND METHODS: The diagnoses of the causa mortis of all patients treated in the Accident and Emergency Department of Hospital de Base in São José do Rio Preto, in the period from July 2004 to June 2005, were identified from autopsy reports to check whether pulmonary thromboembolism was involved. RESULT: A total of 109 deaths due to trauma were detected in this period with pulmonary embolism occurring in 3 (2.75%) patients. CONCLUSION: Pulmonary thromboembolism is an important cause of mortality in trauma patients and so prophylactic measures should be taken during the treatment of these patients.

Rates of thoracic trauma and mortality due to accidents in Brazil.

AIM: To report on the causes of trauma, indexes of trauma, and mortality related to thoracic trauma in one region of Brazil. MATERIALS AND METHODS: This prospective study was performed at the Regional Trauma Center in São José do Rio Preto over a 1-year period, from 1(st) July 2004 to 30(th) June 2005. We included all patients attending the center's emergency room with thoracic trauma and an anatomic injury scale (AIS) ≥ 2. We collected data using a protocol completed on arrival in hospital utilizing the AIS. We studied the types of accidents as well as the mortality and the AIS scores. Prevalence rates were calculated and the paired t-test and logistic regression were employed for the statistical analysis. RESULTS: There were a total of 373 casualties with AIS ≥ 2 and there were 45 (12%) deaths. The causes of thoracic trauma among the 373 casualties were as follows: 91 (24.4%) car crashes, 75 (20.1%) falls, 46 (12.3%) motorbike accidents, 40 (10.7%) stabbings, 22 (5.9%) accidents involving pedestrians, 21 (5.6%) bicycle accidents, 17 (4.6%) shootings, and 54 (14.5%) other types of accident. The severity of the injuries was classified according to the AIS: 224 (60%) were grade 2, 101 (27%) were grade 3, 27 (7.2%) were grade 4, 18 (4.9%) were grade 5, and 3 were (0.8%) grade 6. With respect to thoracic trauma, pedestrians involved in accidents and victims of shootings had mortality rates that were significantly higher than that of those involved in other types of accidents. CONCLUSION: Road accidents are the main cause of thoracic injury, with accidents involving pedestrians and shootings being associated with a greater death rate.

Lesão da artéria subclávia no trauma fechado / Subclavian vascular injury in blunt trauma

Os traumatismos vasculares que acometem a artéria subclávia são pouco comuns no que se refere ao trauma fechado. Geralmente vem associados a lesões de múltiplos órgãos. Apresenta-se, a seguir, um caso de paciente jovem, masculino, vítima de acidente motociclístico. Chegou com sinais de hipovolemia na Unidade de Emergência devido a hemorragia intra abdominal e hematoma expansivo da região subclávia-axilar esquerda, necessitou de tratamento cirúrgico imediato. No relato do caso observa-se dar ênfase ao atendimento inicial realizado dentro dos princípios do ATLS (Advanced Trauma Life Support), tratamento definitivo, com laparotomia exploradora e exploração arterial subclávia esquerda, com enfoque às dificuldades e possibilidades de acesso cirúrgico

Neoplasia papilar cístico-sólida de pâncreas / Papillary cystic and solid neoplasm of the pancreas

The papillary cystic and solid tumor of the pancreas is rare. It occurs predominantly in young women and most present a benign behavior. The most common clinical sign is a large palpable abdominal mass. The pathogenesis of this tumor has attracted a number of investigations but remains unclear. We present a 18 year old white woman with abdominal mass detected after cesarian. Clinical examination showed minimal tenderness. There was no history of weight loss or jaundice. Haematological parameters were normal, except anaemia. The computed tomography was performed and surprisingly showed a 10cm mass in the region of the tail of the pancreas. An extended distal pancreatectomy was performed with splenic preservation. The patient had an uneventful recovery and two months later remains asymptomatic