Associated factors to empyema in post-traumatic hemotorax / Fatores associados ao empiema em pacientes com hemotórax retido pós-traumático

ABSTRACTObjective:to analyze the associated factors with empyema in patients with post-traumatic retained hemothorax.Methods:prospective observational study. Data were collected in patients undergoing PD during emergency duty. Variables analyzed were age, sex, mechanism of injury, side of the chest injury, intrathoracic complications of RH, laparotomy, specific injuries, rib fractures, trauma scores, days to diagnosis, diagnostic method of RH, primary indication of PD, initial volume drained, length of the first tube removal, surgical procedure. Cumulative incidence of empyema, pneumonia and pulmonary contusion and the proportion of patients with empyema or without empyema in each category of each variable analyzed were obtained.Results: the cumulative incidence of PD among trauma patients was 1.83% and the RH among those with PD was 10.63%. There were 20 cases of empyema (32.8%). Most were male in the age from 20 to 29, victims of injury by firearm on the left side of the thorax. The incidence of empyema in patients with injury by firearms was lower compared to those with stab wound or blunt trauma; higher among those with drained volume between 300 and 599 ml. The median hospital lenght of stay was higher among those with empyema.Conclusion:the incidence of PD was 1.83% and RH was 10.63%, these results are consistent with the low severity of the patients involved in this study and consistent with the literature. The incidence of empyema proved to be negatively associated with the occurrence of injury by firearms and positively associated with a drained volume between 300 and 599 ml, compared with lower or higher volumes.

RESUMOObjetivo:analisar os fatores associados ao empiema em pacientes com hemotórax retido pós-traumático.Métodos:estudo prospectivo observacional. Os dados foram coletados de pacientes submetidos à drenagem pleural de emergência. Foram analisadas: idade, sexo, mecanismo de trauma, lado da lesão torácica, complicações intratorácicas decorrentes do hemotórax retido, laparotomia, lesões específicas, fratura de arcos costais, índices de trauma, dias até o diagnóstico, método diagnóstico do HR, indicação primária da drenagem pleural, volume inicial drenado, dias de permanência do primeiro dreno, procedimento cirúrgico. Obteve-se a incidencia acumulada de empiema, pneumonia e contusão pulmonar e a incidência de empiema em cada categoria das variaìveis analisadas.Resultados:a incidência acumulada de drenagem pleural por trauma foi 1,83% e a de hemotórax retido entre aqueles com derrame pleural foi de 10,63%. Houve 20 casos de empiema (32,8%). A maioria tinha entre 20 e 29 anos, era do sexo masculino e sofreu ferimento por arma de fogo. A incidência de empiema entre pacientes com ferimento por arma de fogo foi inferior aos demais mecanismos; superior entre aqueles com volume drenado entre 300 e 599 ml. O tempo mediano de permanência hospitalar foi maior nos pacientes com empiema.Conclusão:as incidências de derrame pleural e hemotórax retido entre aqueles com DP nessa amostra de baixa gravidade dos pacientes foram, respectivamente, 1,83% e 10,63%. A incidência de empiema revelou-se negativamente associada à ocorrência de ferimento por arma de fogo e positivamente associada a volume drenado entre 300 e 599 ml, bem como, ao tempo mediano de permanência hospitalar.

Clotting factor XIII and desmopressin improve hemostasis in uncontrolled bleeding.

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS: Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents.

Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS: Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents. .

[Human bone fragment acting as a secondary projectile set off by an explosion]. / Fragmento de osso humano atuando como projétil secundário decorrente de explosão.

We report a case of a secondary projectile emanated from a fractured human bone from a victim of a bomb explosion. We also refer to the potential of transmition of blood-borne or body fluid pathogens by this mechanism of injury.

Fragmento de osso humano atuando como projétil secundário decorrente de explosão / Human bone fragment acting as a secondary projectile set off by an explosion

We report a case of a secondary projectile emanated from a fractured human bone from a victim of a bomb explosion. We also refer to the potential of transmition of blood-borne or body fluid pathogens by this mechanism of injury.

[Epidemiology of powdered glass-coated kite line injuries: victims admitted to a trauma hospital in Belo Horizonte, Brazil]. / Epidemiologia dos acidentes provocados por linhas com cerol: estudo de vítimas atendidas em hospital de trauma em Belo Horizonte, Brasil.

OBJECTIVE: To describe the characteristics of victims of powdered glass-coated (manja) kite line injuries admitted to a trauma hospital in Belo Horizonte, Brazil. METHODS: Cross-sectional study of victims with powdered glass-coated kite line injuries between 2005 and 2009. Data were obtained retrospectively from medical records. Central tendency and comparison of ratios were used to characterize victims. RESULTS: 211 victims were admitted between 2005 and 2009, 94% of which males. The majority of cases occurred in June and July (37% e 41.7%, respectively). Mean age was 15 years, with no difference between men and women. For the group of victims as a whole, upper limbs were the most prevalent site of injury, although neck and face injuries were the main site of injury among motorcyclists and cyclists. Two deaths (0.95%) were identified, both in motorcyclists, due to injury to neck structures. Residences were concentrated in three administrative areas (East, Northeast and South-central). CONCLUSION: Although the majority of injuries recorded were not severe, fatal injuries can occur, mainly among motorcyclists. Educational and preventive measures are needed to avoid potentially fatal injuries.

Epidemiologia dos acidentes provocados por linhas com cerol: estudo de vítimas atendidas em hospital de trauma em Belo Horizonte, Brasil / Epidemiology of powdered glass-coated kite line injuries: victims admitted to a trauma hospital in Belo Horizonte, Brazil

OBJETIVO: Descrever as características das vítimas de acidentes por linhas com cerol atendidas em hospital de trauma de Belo Horizonte, Brasil. MÉTODOS: Estudo seccional com vítimas de acidentes por linhas com cerol no período de 2005 a 2009. Os dados foram coletados retrospectivamente nos prontuários médicos. Foram utilizadas medidas de tendência central e comparação entre proporções para descrever as características das vítimas. RESULTADOS: Foram identificadas 211 vítimas no período estudado, 94% das quais eram do sexo masculino. Houve concentração do atendimento nos meses de junho e julho (37% e 41,7%, respectivamente). A média de idade foi de 15 anos, não havendo diferença entre os sexos. No conjunto das vítimas, os membros superiores foram o local mais prevalente de lesões, mas entre os motociclistas e ciclistas os principais locais de lesão foram o pescoço e a face. Foram registrados 2 óbitos (0,95%), ambos em motociclistas e causados por lesões das estruturas anatômicas do pescoço. O local de residência das vítimas se concentrou em distritos sanitários de Belo Horizonte (Leste, Nordeste e Centro-Sul). CONCLUSÃO: Apesar da benignidade das lesões identificadas no período estudado, podem ocorrer lesões fatais, principalmente em motociclistas. Medidas educativas e preventivas são necessárias para evitar a ocorrência de lesões potencialmente fatais.

OBJECTIVE: To describe the characteristics of victims of powdered glass-coated (manja) kite line injuries admitted to a trauma hospital in Belo Horizonte, Brazil. METHODS: Cross-sectional study of victims with powdered glass-coated kite line injuries between 2005 and 2009. Data were obtained retrospectively from medical records. Central tendency and comparison of ratios were used to characterize victims. RESULTS: 211 victims were admitted between 2005 and 2009, 94% of which males. The majority of cases occurred in June and July (37% e 41.7%, respectively). Mean age was 15 years, with no difference between men and women. For the group of victims as a whole, upper limbs were the most prevalent site of injury, although neck and face injuries were the main site of injury among motorcyclists and cyclists. Two deaths (0.95%) were identified, both in motorcyclists, due to injury to neck structures. Residences were concentrated in three administrative areas (East, Northeast and South-central). CONCLUSION: Although the majority of injuries recorded were not severe, fatal injuries can occur, mainly among motorcyclists. Educational and preventive measures are needed to avoid potentially fatal injuries.

Urgência em atenção básica em saúde

Módulo da disciplina optativa "Rede de atenção: urgências" do Curso de Especialização Estratégia Saúde da Família (2014). Esta disciplina pretende propiciar o desenvolvimento do raciocínio e a aquisição de habilidades, visando melhorar a competência diante do atendimento a pacientes graves ou na eminência de um evento agudo em qualquer faixa etária, o que pode ocorrer em qualquer Unidade Básica de Saúde. O conteúdo da disciplina está distribuído em cinco seções: Seção 1: Fluxos na urgência - Seção 2: Atendimento inicial às urgências - Seção 3: Urgências clínicas - Seção 4: Primeiro atendimento ao trauma - Seção 5: Principais urgências neurológicas

Apendicite aguda por Enterobius vermicularis: relato de caso e revisão da literatura / Acute appendicitis and Enterobius vermicularis: case report and review of the literature

O parasitismo pelo Enterobius vermicularis é assintomático na maioria dos pacientes. A sintomatologia, quando presente, caracteriza-se, principalmente, pelo prurido anal, entretanto, podem estar presentes dores abdominais esporádicas sem suspeita da parasitose. A relação entre apendicite aguda e enterobíase é rara e motivo de controvérsia. A presença do parasito no apêndice cecal, segundo alguns autores, pode ser incidental, embora possa ser responsável pelo desenvolvimento de apendicite crônica. Relata-se, neste trabalho, o desenvolvimento de apendicite aguda em um paciente, provocada por Enterobius vermicularis, e revisão da literatura sobre o assunto.

Enterobius vermicularis infection is asymptomatic in the majority of the patients. When symptoms do appear, the most characteristic is the very strong anal itching sensation. Abdominal tenderness may occur sporadically, however, it does not direct for the diagnosis. The relationship between acute appendicitis and enterobiasis is debatable and controversial. Many believe that the presence of the parasite in the appendix is an incidental operative finding, although, enterobiasis has been attributed to cases of chronic appendicitis. We report a case of acute appendicitis provoked by Enterobius vermicularis and review the literature on the topic.

Hyperbaric oxygen therapy aggravates liver reperfusion injury in rats / Oxigenoterapia hiperbárica agrava lesão de reperfusão hepática em ratos

PURPOSE: To evaluate the effects of hyperbaric oxygen (HO) therapy in the protection against liver ischemia/reperfusion injury. METHODS: Thirty-two male Wistar rats were divided into four groups of eight animals each: group A - laparotomy and liver manipulation, group B - liver ischemia and reperfusion, group C - HO pretreatment for 60 min followed by liver ischemia and reperfusion, and group D - pretreatment with ambient air at 2.5 absolute atmospheres for 60 min followed by liver ischemia and reperfusion. Plasma was assayed for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). Intra-arterial blood pressure was monitored continuously. Myeloperoxidase activity in the liver and lung was assessed 30 min after reperfusion. RESULTS: Plasma AST, ALT and LDH increased after reperfusion in all animals. Plasma ALT values and myeloperoxidase activity in the liver parenchyma were higher in HO-pretreated animals than in groups A, B and D. HO had a negative hemodynamic effect during liver reperfusion. CONCLUSION: Liver preconditioning with hyperbaric oxygen therapy aggravated liver ischemia/reperfusion injury in rats as demonstrated by plasma ALT and liver myeloperoxidase activity.

OBJETIVO: Avaliar os efeitos da oxigenoterapia hiperbárica (OH) como método preventivo da lesão de isquemia e reperfusão (LIR) do fígado. MÉTODOS: Trinta e dois ratos machos Wistar foram distribuídos em quatro grupos de oito animais cada: A - laparotomia e manipulação hepática, B - isquemia e reperfusão hepática, C - pré-tratamento com OH por 60 minutos seguido de isquemia e reperfusão hepática e D - pré-tratamento com ar ambiente a 2,5 atmosferas absolutas por 60 minuto e isquemia e reperfusão hepática. Dosagens seriadas de AST, ALT e DHL foram realizadas. A pressão intra arterial foi monitorizada continuamente. O grau de infiltração leucocitária no fígado e pulmões foi inferido pela dosagem de mieloperoxidade tecidual. RESULTADOS: O nível sérico de AST, ALT e DHL aumentou em todos animais. Os animais expostos a OH apresentaram níveis de ALT e infiltração leucocitária hepática maior que os demais. A OH apresentou efeitos hemodinâmicos negativos durante a reperfusão hepática. CONCLUSÃO: O pré-condicionamento hepático por oxigenoteraia hiperbárica agrava a lesão de isquemia e reperfusão hepática em ratos.

Hyperbaric oxygen therapy aggravates liver reperfusion injury in rats.

PURPOSE: To evaluate the effects of hyperbaric oxygen (HO) therapy in the protection against liver ischemia/reperfusion injury. METHODS: Thirty-two male Wistar rats were divided into four groups of eight animals each: group A - laparotomy and liver manipulation, group B - liver ischemia and reperfusion, group C - HO pretreatment for 60 min followed by liver ischemia and reperfusion, and group D - pretreatment with ambient air at 2.5 absolute atmospheres for 60 min followed by liver ischemia and reperfusion. Plasma was assayed for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). Intra-arterial blood pressure was monitored continuously. Myeloperoxidase activity in the liver and lung was assessed 30 min after reperfusion. RESULTS: Plasma AST, ALT and LDH increased after reperfusion in all animals. Plasma ALT values and myeloperoxidase activity in the liver parenchyma were higher in HO-pretreated animals than in groups A, B and D. HO had a negative hemodynamic effect during liver reperfusion. CONCLUSION: Liver preconditioning with hyperbaric oxygen therapy aggravated liver ischemia/reperfusion injury in rats as demonstrated by plasma ALT and liver myeloperoxidase activity.

Doença do refluxo gastroesofágico / Gatroesophageal reflux disease

A doença do refluxo gastroesofágico (DRGE) prima pela importância, incidência e pelas complicações e em todas as idades e ambos os sexos. O êxito terapêutico depende da melhor indicação medicamentosa ou da indispensável intervenção cirúrgica. O artigo faz uma atualização da epidemiologia, fisiopatologia, sintomatologia, classificação, propedêutica e terapêutica da doença.

Gastroesophageal reflux disease has high incidence and complication rate. It affects all age groups and both genders. Therapeutic success depends on correct pharmacologic management and precise surgical indication and technique. This article reviews main aspects of gastroesophageal reflux disease from its history going through epidemiology, classification, physiopathology, clinical presentation, diagnosis and treatment.

Animal model of the abdominal compartment syndrome as a single insult and as a second insult in rats

The objective of this paper was to develop a clinically relevant abdominal compartment syndrome experimental model, as a single insult and as a second insult flowing hemorrhagic shock. In the single insult model, Sprague-Dawley male-rats are anesthetized, invasively monitored (central venous pressure and mean arterial pressure), and mechanically ventilated during intraperitoneal injection of air to provoke the abdominal compartment syndrome (25 mmHg) for 60 minutes. In the two insult model, Sprague-Dawley male-rats are anesthetized, invasively monitored (mean arterial pressure) and bled to a mean arterial pressure of 30 mmHg for 45 minutes. Fluid resuscitation is accomplished by infusing 0.9 percent sodium chloride solution (0.9 percent NaCl) 33.2 ml/kg plus 75 percent of shed blood volume. During this phase a laparotomy is performed. Two hours after the beginning of the hemorrhagic shock phase the animals are anesthetized, intubated (orotracheal), mechanically ventilated (mean arterial pressure), and the intra-abdominal pressure is increased to 25 mmHg for 60 minutes, as a second insult. A 0.9 percent NaCl solution is infused during this phase (45 ml/kg/h). Hemorrhagic shock and the abdominal compartment syndrome behave as clinically relevant additive insults.

Avaliação da resistência de suturas duodenais com ou sem omentoplastia pediculada: estudo experimental em ratas / Study of the duodenal sutures resistance with or without omental patch: experimental study in rats

Estudamos os efeitos da omentoplastia pediculada como método de reforço de suturas sobre o duodeno. Foram utilizadas 135 ratas HOLTZMAN, divididas em nove subgrupos de quinze ratas cada (n=15). Após a realização de uma lesão padronizada na segunda porção do duodeno, os animais, exceto os do grupo controle, foram submetidos, dependendo do subgrupo, a dois tipos diferentes de reparos: n sutura da lesão e omentoplastia pediculada de reforço. n sutura da lesão sem omentoplastia de reforço. A avaliação da resistência do reparo da lesão duodenal, foi realizada através da insuflação de ar até a ruptura do segmento testado. Esta avaliação foi feita em três períodos pós-operatórios diferentes: dois, sete e 14 dias em todos os subgrupos. O coeficiente de variação (CV) foi utilizado como forma de avaliar a variabilidade interna das variáveis centrais do estudo. Nos casos em que a análise indicou a existência de influência de algum fator ou de interações entre os fatores estudados, realizamos as comparações múltiplas de médias segundo o teste "Least Significant Difference" (LSD). Os achados mostraram que a realização de uma omentoplastia pediculada como reforço de um reparo sobre uma lesão padronizada do duodeno, quando comparado a uma simples sutura, não aumentou a resistência do reparo. Não importando o dia de pós-operatório em que o teste de resistência foi realizado. Os achados histológicos demonstraram que a omentoplastia pediculada proporcionou reação inflamatória intensa no nível do reparo

Estudo anatômico da veia renal esquerda: sua aplicaçäo à anastomose esplenorrenal / Anatomic study of the left renal vein: application on the spleno-renal anastomosis

Foram dissecados 55 retroperitônios de cadáveres, para o estudo das relaçöes da veia renal esquerda com o duodeno e aorta. Foram encontrados 5 por cento de variaçöes anatômicas, incluindo veia dupla, retroaórtica e trajeto descendente. Algumas consideraçöes säo feitas sobre a sua aplicaçäo à anastomose esplenorrenal, no tratamento da hipertensäo porta

Cistoadenocarcinoma papilífero do pâncreas / Papilary-cystadenocarcinoma of the pancreas

Apresentamos uma paciente portadora de cistoadenocarcinoma de pâncreas cujo tratamento cirúrgico possibilitou uma sobrevida de 14 anos, ainda assintomática.

Anatomia das veias tireoideas inferiores: aplicaçäo cirurgica / Anatomy of inferior thyroid veins: surgical application

Os autores fazem um estudo anatomopográfico sobre as veias tireóideas inferiores (VTI), dissecando 27 cadáveres e associando ao estudo de várias referências sobre o assunto. Relembram que o acesso mediastinal alto, numa hemorragia por rotura da veia, em dissecçöes inferiores difícies, propiciam o controle direto das mesmas