André Vicente Bigolin

Proposta de escore de risco para predição de fibrilação atrial após cirurgia cardíaca

Objective: Atrial fibrillation (AF) is a common complication following cardiac surgery and is associated with an increased patient morbidity and mortality. The objective of this study was to develop a risk index proposal to predict AF after cardiac surgery. Methods: A prospective observational study in that 452 patients were selected to assess the incidence and risk factors associated with postoperative AF. Only patients following cardiac surgery were selected. Continuous cardiac monitor and daily electrocardiogram were assessed. The most associated in a multivariable logistic model were selected for the risk index. Results: The average incidence of AF was 22.1%. The most associated factors with AF were: patients older than 75 years of age, mitral valve disease, no use of a beta blocker, withdrawal of a beta-blocker and a positive fluid balance. The absence risk factor determined 4.6% chance to postoperative AF, and for one, two and three or more risk factors, the chance was 16.6%, 25.9% and 46.3%, respectively. Conclusion: In a multivariable logistic model was possible to develop a risk index proposal to predict postoperative AF with a major risk of 46.3% in the presence of three or more risk factors. Descriptors: Atrial fibrillation. Thoracic surgery. Risk

May polyester with collagen coating mesh decrease the rate of intraperitoneal adhesions in incisional hernia repair

BACKGROUND Among meshes used in incisional hernias in open technique repair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. AIM To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. METHODS Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. RESULTS There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). CONCLUSION There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.

Fratura do quadril: avaliação pós-operatória do resultado clínico e funcional

ABSTRACT Objective: To evaluate the clinical and functional outcomes of patients submitted to surgery for hip fracture through the ASA score and time for definitive surgical treatment. Method: During one year, 154 patients with hip fractures, aged 65 years and over, were operated on. Data from the pre-operative ASA score and time awaiting operation were obtained. Two years after the operation, Zuckerman´s Functional Recovery Score (FRS) questionnaire was used to assess the current functional capacity of the patients. Results: Mortality in the first post-operative year was different between patients with an ASA 3 or 4 compared to those classified as ASA 1 or 2 group (significant data p 0.05). There was no significant difference between the group operated within 48 hours of admission and the group operated after 48 hours in relation to mortality or current functional capacity (p>0.05). The group aged 80 and over showed significantly higher mortality than the group aged 65 to 79 years through the end of the second post-operative year (p>0.05). Conclusion: A preoperative ASA score and an age of 80 or over may be considered factors associated with higher mortality two years post-operatively after hip fracture. In isolation, time awaiting surgery was not significant.

Analysis of adhesions resulted from mesh fixation with fibrin sealant and suture: experimental intraperitoneal model

OBJECTIVE To compare surgical fixation of polypropylene mesh (PP) and coated polypropylene mesh (PCD) using polypropylene suture and fibrin glue, as for the formation of intraperitoneal adhesions. METHODS A sample of 46 female Wistar rats were randomized into six groups: two control groups, with five rats each, were subjected to one medial incision (MI) and the other to a U-shaped incision (UI), none of these groups received the mesh. Two groups of PP mesh, with ten rats, fixed with suture (PPF), the other with six rats, fixed with biological glue (PPC). And two groups of PCD mesh, at first, with ten animals, the mesh was fixed with sutures (PCDFs) and the second with ten animals with biological glue (PCDC). RESULTS After 21 days, the control groups showed no significant adhesions. The PPC group showed a lower degree of adhesion than the PPF group (p = 0.01). There was no difference between the groups with PCD. CONCLUSION Comparison of fixation was statistically different only with PP mesh, with lesser degrees of adherence when using the glue. Adhesions were predominantly located at the extremities of the meshes studied.

Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid

OBJECTIVE To compare intraperitoneal adhesion formation with placement of polypropylene mesh and use of lightweight polypropylene mesh coated with omega-3 fatty in rats. METHODS Twenty-seven Wistar rats were randomized into three groups. In group 0 no mesh was placed; in group 1 we implanted a polypropylene mesh; and in group 2 there was implantation of a polypropylene mesh coated with omega-3 fatty acid. We evaluated adhesions presence and degree, breaking strength, percentage of area covered and retraction of the implanted meshes. RESULTS Group 0 had no adhesion. Groups 1 and 2 showed adhesions on the surface of the mesh, omentum, liver and intestinal loops. There were grades 1 and 2 adhesions in 100% of the polypropylene coated group and in 60% of the polypropylene group. The remaining were grade 3 adhesions, and differed significantly between groups (p <0.001). The breaking strength of adhesions on the polypropylene coated group was significantly higher than with the polypropylene alone (p = 0.016). There was no difference in mesh retraction or area covered by the mesh. The analysis of the mesh coated with omega-3 fatty acid distribution showed adhesions preferentially located at the edges when compared to polypropylene, predominantly in the center. CONCLUSION The type of adhesions, percentage of surface affected and retraction were not significantly different between meshes. The fatty acids coated mesh had a lower degree of adhesions and these required a greater force to rupture, possibly by their occurrence at the edges of the mesh.

Thoracotomy versus transhiatal esophageal dissection: which is the best surgical approach to short esophagus?

PURPOSE To evaluate different approaches performed to obtain a more significant esophageal length. METHODS An experimental model using 28 cadavers was conceived. Randomized groups: Group A (n=10) underwent laparotomic transhiatal approach; Group B (n=9) which differed from the first in the conduction of a wide phrenotomy and Group C (n=9) esophageal dissection was performed through a left anterolateral thoracotomy. RESULTS Final length variations for Group A were 2.12cm and 3.29cm and for Group B 3.24 cm and 3.66cm, without and with esophageal traction, respectively. In Group C length gain observed was 3.81 cm. The mediastinal dissections conducted through the hiatus was considered the procedure that produced the better esophageal mobilization, and the association of wide phrenotomy significantly improved the results. CONCLUSION The mediastinal dissection was the most effective to improving gain in abdominal esophagus. When toracotomy and laparotomy were compared, no significant differences were observed in the outcome.

Description of the technique of upper gastrointestinal series radiological examination for the evaluation of the esophagus, stomach and duodenum of Wistar female rats

PURPOSE To evaluate the anatomy of female Wistar rats and the workability of contrast radiography as a technique to investigate the gastrointestinal series. METHODS Eight adult female Wistar rats were undergone to the contrast radiography as anteroposterior incidence and as posterior incidence in profile. The radiological examination was conducted at a 45 degrees angle to the radiological table. Film-focus distance (FFD) was 100 cm, film-object distance (FOD) was 0 cm, and object-focus distance (OFD) was 100 cm. An orogastric probe was used to inject barium contrast at 5-min intervals, for a total of four applications. After the radiological examination, animals were necropsy for confirmation of the radiological findings, and the radiographs were the absence of the normal anatomy variations inspected and described by an experienced radiologist. RESULTS All the radiographs produced achieved satisfactory results in terms of position, exposure, location and quality. The upper esophageal sphincter (UES) was identified in the esophagus at the nerve C2, the lower esophageal sphincter (LES) was identified between spinal cord segments L1 and L2, the thoracic-abdominal junction was observed at T10, the esophageal-gastric junction (EGJ) at T13-L1, with the abdominal portion in the epigastric region. The stomach was observed mostly in the epigastric region, left hypochondrium, left and mesogastric flank. The duodenum findings presented higher variation, with most findings identified in the epigastric region, right hypochondrium, right flank and mesogastric ileal fossa at T13-L5. CONCLUSION Contrast radiology is useful and may be employed to assess the anatomy of the animal being studied. The experimental model described afforded to fully identify all organs investigated, as well as other occasional relevant findings. No anatomical anomalies in the subsequent necropsy, confirming the radiographic findings.

Radiological evaluation of the patency of duodenal-esophageal anastomosis during a long postoperative follow-up: effectiveness of an alkaline reflux model in rats

Background: Performing experimental studies has played an important role in acquiring knowledge about esophageal carcinogenesis. In this context, the choice of a more reliable experimental model requires proof of its effectiveness in order to lend greater credibility to the results. The objective of this study was to evaluate the patency of duodenal-esophageal anastomosis during long-term postoperative follow-up in rats. Methods: This was an experimental study in which 45 female Wistar rats were used. A side-to-side anastomosis was performed, going from the anterior side of the esophagus to the second duodenal portion. A standardized radiological technique was used to carry out a contrasted radiological study of the esophagus, stomach, and duodenum during weeks 4, 12, 20, and 30 after surgery. Different contrast media were used, and the animals were divided into groups, ie, group 1 (100% barium sulfate), group 2 (50% barium sulfate), and group 3 (60% aqueous iodinated contrast media). Contrast radiographs were taken in each group at weeks 4, 12, 20, and 30 after the surgical procedure. The radiographic images were evaluated by two radiologists who were blinded regarding the contrast groups. Macroscopic evaluation of each animal was compared with the radiological findings. Results: Postoperative mortality was 13.33%. The remaining animals were divided into study groups. All the contrast radiological examinations showed evidence of the location of the esophagus, stomach, and proximal portion of the intestine, and demonstrated the laterolateral relationship of the distal esophagus and the duodenum in the epigastric region. Patency of the anastomosis was observed at each examination period. The different contrast media used were able to demonstrate this outcome shortly after the first phase of injection. Necropsies corroborated the radiological findings. Conclusion: Regardless of the contrast agent used, contrasted radiography revealed that side-to-side duodenal-esophageal anastomosis in rats allowed patent communication during long-term postoperative follow-up.