Fábio Silveira

Morbimortalidade da reconstrução de transito intestinal colônica em hospital universitário: análise de 42 casos

OBJECTIVES: To study demographyc caractheristics, morbidity and mortality associated to the procedure. METHODS: Retrospective study of colostomy closure in 42 patients. Male sex was predominant (80,9%) with median age of 42 years. Causes of colostomy were traumatic in 50% and clinic acute abdomen in 29% of the cases. Terminal colostomy was the more frequent procedure (65%) followed by loop colostomy in 35% of the cases. The predominant anastomotic technique was manual (69,05%). The morbidity rate was 26,2%, including reoperation (9,52%) and colonic fistulae in 7,14% cases. No postoperative wound infection was observed. Overall mortality rate was 2,38%. CONCLUSION: The results observed in a university hospital are as good as reported in world literature. Adequate pre and postoperative care works together with surgeon experience on colostomy closure surgeries. The surgical technique must be adopted using a randomized study, allowing establishment of a protocol.

Avaliação dos níveis séricos de interleucina-6 e interleucina-10 nos pacientes submetidos à colecistectomia laparoscópica versus convencional

OBJECTIVE To correlate serum preoperative and postoperative interleukin-6 and interleukin-10 levels in patients undergoing laparotomy versus laparoscopic cholecystectomy. METHODS From a total of 20 patients, 18 were included in the study, nine underwent cholecystectomy by laparoscopy and the other nine by laparotomy. Serum concentrations of IL-6 and IL-10 were measured in both groups. Blood samples were obtained in the times of 24 hours preoperatively and four, 12 and 24 hours after the procedure. The groups were compared regarding age, gender, body mass index (BMI), duration of anesthesia and operation. RESULTS There was no significant statistical differences between groups related to age, gender, BMI, duration of anesthesia and operation. The comparison between the two procedurs demonstrated statistical differences for IL-6 in time 12 hours after operation (218.64 pg/ml laparotomic versus 67.71 pg/ml laparoscopic, p = 0.0003) and for IL-10 in time 24 hours after the procedure (24.46 pg/ml open versus 10.17 pg/qml laparoscopic, p <0.001). CONCLUSION There was an Increase in plasma levels of interleukin-6 and 10 after surgical trauma with a significant increase in levels of interleukins in the laparotomic group in comparison with the laparoscopic group.

One Hundred Pancreas Transplants Performed in a Brazilian Institution

After decades of controversy surrounding the therapeutic validity of pancreas transplantation, the procedure has become accepted as the preferred treatment for selected patients with type 1 diabetes mellitus. Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center: 88 simultaneous pancreas-kidney transplantation and 12 pancreas transplantations alone. Pancreas graft management of the exocrine drainage technique involved enteric drainage in 8 (all simultaneous pancreas-kidney) and the bladder in 92 cases. The recipient systemic venous system was used for the pancreas graft venous effluent in all cases. Our overall results have shown that the number of functioning pancreatic grafts was 64 of 100. Graft losses were: rejection (n = 8), venous thrombosis (n = 9), arterial thrombosis (n = 1), or surgical complications such as anastomotic leak (n = 3), perigraft infection (n = 10), pancreatitis of the graft (n = 5). Most cases of pancreatitis (80%) had preservation times exceeding 18 hours. Despite surgical and immunosuppressive complications, our impression was that pancreas transplantation was a highly effective therapy for diabetes mellitus. After 7 years of the program and 100 transplantations, we believe that there is a major role for transplantation in diabetes management.

Análise da redistribuição de calor com agentes inalatórios, em ratos submetidos a laparotomia e pneumoperitônio, através da termografia infravermelha

BACKGROUND AND OBJECTIVES Anesthesiology involves the handling of situations inherent to anesthetic and surgical procedures which lead to patients thermal homeostasis unbalance, with noxious physiological effects. This study aimed at qualifying and quantifying thermal redistribution in rats subjected to inhalation anesthesia, during induction and in surgical situations of laparotomy and increased intra-abdominal pressure. METHODS The study involved 90 rats, submitted to inhalation anesthesia, which were distributed in three groups: halothane; isoflurane; sevoflurane. Each group was divided in subgroups: I - control; II - median laparotomy with bowel exposure; III - 15 mmHg Increase in intra-abdominal pressure. Heat loss was measured by an esophageal probe and infrared thermal image. RESULTS There were no significant differences among inhalation anesthetics regarding heat loss between groups I and II. In group III, there was a difference between isoflurane and sevoflurane and isoflurane was responsible for the highest heat loss.

[Analysis of heat loss using inhalation agents in rats subjected to laparotomy and increased intra-abdominal pressure, using digital infrared thermal image].

BACKGROUND AND OBJECTIVES Anesthesiology involves the handling of situations inherent to anesthetic and surgical procedures which lead to patients thermal homeostasis unbalance, with noxious physiological effects. This study aimed at qualifying and quantifying thermal redistribution in rats subjected to inhalation anesthesia, during induction and in surgical situations of laparotomy and increased intra-abdominal pressure. METHODS The study involved 90 rats, submitted to inhalation anesthesia, which were distributed in three groups: halothane; isoflurane; sevoflurane. Each group was divided in subgroups: I - control; II - median laparotomy with bowel exposure; III - 15 mmHg Increase in intra-abdominal pressure. Heat loss was measured by an esophageal probe and infrared thermal image. RESULTS There were no significant differences among inhalation anesthetics regarding heat loss between groups I and II. In group III, there was a difference between isoflurane and sevoflurane and isoflurane was responsible for the highest heat loss.

Primeiro transplante duplo de fígado esquerdo intervivos adultos do Brasil

Living donor liver transplantation expanded the therapeutic possibilities for liver failure patients. The necessary correct match between the liver mass donated and received sometimes limits its use. A case that was used two left liver grafts from adult living donors is reported.

Influência da técnica de anestesia no tempo de ocupação de sala cirúrgica nas operações anorretais

INTRODUCTION: around ninety percent of anorectal surgical procedures are performed as day cases. The choice of a proper anesthetic technique is important to achieve reduced time in the operating rooms, hospital stay and low costs. There is no evidence in the literature that a superior type of anesthesia for these procedures exists. OBJECTIVE: to compare the time spent on operating rooms in patients submitted to anorectal surgical procedures through spinal anesthesia (0,5% bupivacaine) with combined anesthesia (propofol and local perineal block with 2% lidocaine and 0,5% bupivacaine). METHODS: Fifty patients were operated with spinal anesthesia (group one) and forty-nine patients were operated with combined anesthesia (group two). The type of anorectal procedure and the time spent on anesthetic and surgical procedures were analyzed. RESULTS: There were no significant differences between the studied groups regarding the type of operation, gender and age. The time of anesthetic and surgical procedures was 53,1 minutes in group one and 44,08 minutes in group two (p=0,034). CONCLUSIONS: These anesthetic techniques had similar efficacy. There was a lower time of anesthetic and surgical procedures in the combined anesthesia group, with statistical significance.

Perda de calor determinada pela exposição das alças intestinais em ratos

OBJETIVO: Esta pesquisa tem por objetivo quantificar a perda de energia calorica que ocorre ao realizarmos uma laparotomia com exposicao de alcas intestinais a atmosfera em ratos; determinar a perda termodinâmica representada por watts/m2 em funcao da superficie peritoneal exposta do animal e discutir meios de tratamento para a perda de calor. METODO: Foram utilizados 30 ratos machos, Wistar, distribuidos em cinco grupos de seis animais cada, com idade de 8 a 9 semanas, com o peso entre 200 e 220g. No grupo A ou grupo controle, os animais foram submetidos a anestesia inalatoria. No grupo B, os ratos foram submetidos a uma laparotomia mediana com exposicao das alcas intestinais. Nos grupos C, D e E, os ratos foram submetidos a uma laparotomia mediana com exposicao das alcas intestinais e tratados respectivamente, por gaze umida, gaze seca e empacotamento com filme de poliester. RESULTADOS: Observou-se uma significativa perda de energia calorica quando se realiza uma laparotomia com exposicao das alcas intestinais em ambiente nao controlado, da ordem de 620,72 kJ/m2 A analise da perda termodinâmica, em funcao da superficie corporea exposta do rato, apresentou um valor de 382,97 W/m2. CONCLUSOES: Na avaliacao dos diferentes tipos de tratamento utilizados para prevenir a perda de calor corporeo, ficou evidente que a utilizacao do filme de poliester (PVC) foi o metodo mais efetivo na conservacao do calor, em relacao a gaze seca e, ou umida respectivamente.

Ferimentos cervicais: análise retrospectiva de 191 casos

BACKGROUND: The study proposes to assess the demographics and management of neck injuries. METHODS: A retrospective review of 487.128 emergency department medical records from 01/1996 to 06/2001 was conducted. Out of the 378 patients selected for the analysis, 153 were excluded due to associated lesions and 14 because of death. The group of patients analyzed (n=191) had exclusively neck lesions. Injury location, kinetics of trauma, platysma involvement, signs and symptoms, admission hour and management were evaluated. RESULTS: One hundred sixty four (86%) patients were male. Mean age was 28 years (range, 10-72). Ninety (47%) injuries were caused by firearms and 88 (46%) were stab wounds. The main period of admission was between 08 pm and 04 am. The location of the lesions was 53% in the left, 45% in the right, and 2% in the median line; 36% of them being classified as zone I, 55% as II, and 9% as III. There was platysma penetration in 101 patients , half of them (n=51) presented signs and symptoms suggestive of injury, and were consequently subjected to surgical intervention. Twenty-four (47%) operative interventions were non-therapeutic. Forty-one patients (45%) were medically treated on the basis of clinical assessment. CONCLUSIONS: Young males are the most frequent victims of neck injuries. It occurs mostly in the Zone II , and the incidence of firearm and stab wounds were equivalent as a trauma mechanism. The necessity of a selective management of neck lesions is clearly evident. Regarding penetrating zone II neck injuries, the treatment may be adequated with the resources of trauma services.

Experiência obtida em 100 transplantes de pâncreas

OBJECTIVE Report our experience with 100 pancreas transplants performed in a period of seven years. METHODS. Between January 2001 and January 2008, 100 patients underwent pancreatic transplantation at our center, 88 simultaneous pancreas kidney transplantation (SPK) and 12 pancreas transplantation alone (PTA). All of these were primary transplants. Pancreas graft management of the exocrine drainage technique involved enteric drainage in 8 (all SPK) and bladder in 92 cases. The recipient systemic venous system was used for the pancreas graft venous effluent in all cases. Our last thirty patients submitted to SPK did not receive any induction therapy regardless of the PRA. SPK received basiliximab and PTA patients received thymoglubulin. Maintance imunossupression was with TAC, MMF and corticosteroids. Graft perfusion volume was limited to 800 ml of Celsior or UW solution. RESULTS. Overall results show that the number of functioning pancreatic grafts is 64 after 100 performed. Graft losses were: rejection (8 cases), venous thrombosis (9 cases) arterial thrombosis(1 case), or surgical complications such as anastomotic leak (3 cases), perigraft infection (10 cases), pancreatitis of the graft(5 cases). Rejection was observed less frequently in SPK recipients 5 cases (5/92 recipients) than PTA recipients (3/12). Death was observed in 24 cases. CONCLUSION. Our impression is that pancreas transplantation is highly effective therapy for diabetes mellitus and there is still a role in the diabetes treatment for allograft transplantation in a near future.