Flávio Kreimer

Resposta terapêutica e inflamatória de ratos com peritonite secundária submetidos ao uso tópico de ampicilina/sulbactam

OBJETIVOS: A peritonite aguda representa uma importante causa de sepsis e obito nas unidades de terapia intensiva e cirurgia. Classicamente o seu tratamento deve incluir: a administracao sistemica de antibioticos, a remocao mecânica dos contaminantes e a restauracao da integridade gastrintestinal. A utilizacao de antibioticos diretamente na cavidade peritoneal e controversa. Estudo com o objetivo de avaliar o uso terapeutico, intraperitoneal da ampicilina associada ao sulbactam. METODOS: foram mensurados os niveis plasmaticos do oxido nitrico, bem como a contagem de eosinofilos, linfocitos, monocitos e neutrofilos no sangue e no lavado peritoneal, utilizando-se modelo de peritonite em ratos (ligadura-transfixacao cecal). Vinte quatro ratos Wistar, machos, foram divididos em quatro grupos de seis animais, assim distribuidos: grupo A: metodo de inducao de peritonite - soltura da ligadura + tratamento com soro fisiologico; grupo B: metodo de inducao de peritonite + soltura da ligadura + tratamento com soro fisiologico acrescido de ampicilina / sulbactam; grupo C: metodo de inducao de peritonite + soltura da ligadura-transfixacao cecal; e grupo D: laparatomia para realizacao de lavado peritoneal mais coleta de sangue. A ligadura-transfixacao do cecum permaneceu por 24 horas, antes do tratamento instaurado. Foi realizada uma relaparotomia nos 18 ratos com coleta de liquido de lavado peritoneal e sangue. Foram dosados os niveis plasmaticos de oxido nitrico e determinado o numero de eosinofilos, linfocitos, monocitos e neutrofilos no sangue e no lavado peritoneal. RESULTADOS: Nao ocorreu diferenca estatisticamente significante (p > 0,05) nos niveis de oxido nitrico, bem como no numero de eosinofilos, linfocitos, monocitos e neutrofilos no sangue e no lavado peritoneal, entre os grupos. CONCLUSAO: Neste estudo, concluiu-se que: a utilizacao de ampicilina associada a sulbactam por via intraperitoneal nos ratos com peritonite fecal: nao modificou a sobrevida; nao alterou os niveis plasmaticos de oxido nitrico; nao alterou a contagem de eosinofilos, linfocitos, monocitos e neutrofilos tanto no sangue como no lavado peritoneal.

Fatores prognósticos de mortalidade em pacientes com trauma cardíaco que chegam à sala de cirurgia

BACKGROUND: The purpose of this study is to outline the postoperative complications, lethality rates and associated risk factors (trauma mechanism, anatomic site injury, location of surgical intervention, associated injuries, transfusion need and anatomic trauma scores) in patients with cardiac wounds presenting vital signs at admission in the operation room. METHODS: This is a retrospective and analytic study using charts of 52 patients, who underwent thoracotomy for treatment of cardiac injuries in a trauma center in northeastern Brazil between July/91 and March/97. RESULTS: The most frequent injury was caused by stab wound, in 28 patients (53.85%), followed by gunshot wounds in 24 patients (46.15%) Isolate right ventricle wounds occurred in 25 cases (48.08%). The median for anatomic trauma scores were: injury severity score (ISS)=26; penetrating trauma index (PTI)=23; penetrating thoracic trauma index (PTTI)=20; and penetrating cardiac trauma index (PCTI)=15. Postoperative complication rate was 36.54% and the lethality rate was 13.45%. Postoperative bleeding, reoperation and use of more than three packaged red blood cells increased de relative risk to lethality. The anatomic trauma scores were not associated with the relative risk to lethality. CONCLUSION: The majority of patients treated for cardiac injuries presented good predictors for survival, justifying our low mortality rates.

PREVALENCE OF INCIDENTAL GALLBLADDER CANCER IN A TERTIARY-CARE HOSPITAL FROM PERNAMBUCO, BRAZIL

BACKGROUND Gallbladder cancer is sometimes incidentally uncovered following cholecystectomy for gallstones diseases. The supposed highly variable prevalence of incidental gallbladder cancer through our country is unknown. OBJECTIVE To explore the prevalence of incidental gallbladder cancer in our tertiary-care hospital. METHODS A cross-sectional study was carried out on patients who consecutively underwent cholecystectomy due to gallstones disease at Faculdade Pernambucana de Saúde, Instituto de Medicina Integral Professor Fernando Figueira - FPS/IMIP, from January, 2007 to December, 2010. Data on incidental gallbladder cancer patients were explored for prevalence estimation and description of our experience with the management of this malignancy. RESULTS Our analysis involved 2018 patients with a marked predominance of women (n=1.697; 84.1%) over men (n=321; 15.9%). The 3-year prevalence estimate of 0.34% was recorded for incidental gallbladder cancer in our sample. Regarding tumor staging, there were 1 T1a, 1 T1b, and 5 T2 adenocarcinoma tumors. Laparoscopic cholecystectomy alone was performed for the T1a tumor, and additional radical surgery was performed in five others. One patient presented metastatic disease at the time of repeat surgery. The final pathology revealed residual/additional disease in all T2 tumors after radical surgery whereas the T1b patient underwent a salvage Whipples procedure due to a secondary distal cholangiocarcinoma. The patient with T1a tumor is alive after 3-year follow-up but all of the others died because of disease recurrence/progression up to 12 months. CONCLUSION This study confirms the poor prognosis of Gallbladder cancer even when incidentally diagnosed following cholecystectomy and supposes a 3-year prevalence estimate of 0.34% for incidental gallbladder cancer in our Center from Pernambuco State, Brazil.

Resultados iniciais da oxigenoterapia hiperbárica empacientes em lista de espera para o transplante hepático

RACIONAL: A funcao hepatica e um processo complexo que envolve multiplos eventos celulares. Ela, em pacientes cirroticos, pode se beneficiar da terapia com oxigenio hiperbarico. OBJETIVO: Avaliar, de forma preliminar, os dados clinicos e laboratoriais sobre a funcao hepatica em pacientes cirroticos em lista de espera para transplante hepatico, submetidos a oxigenoterapia hiperbarica. METODO: Estudo prospectivo com intervencao, no qual 10 pacientes foram escolhidos aleatoriamente entre os pacientes cirroticos em lista de espera para transplante hepatico. A idade variou de 20 a 65 anos, e todos apresentaram escore MELD maior que 15. Todos os pacientes foram submetidos a nove sessoes de terapia com oxigenio hiperbarico, em dias alternados com a duracao de 60 minutos por sessao, com atmosfera de oxigenio de 100% e pressao de 2,8 ATM. As variaveis dependentes foram os valores laboratoriais bioquimicos e hematologicos, avaliados antes e apos sessoes de terapia hiperbarica de oxigenio, alem de parâmetros clinicos, considerando-se tambem o Child-Turcotte-Pugh e o MELD. A analise estatistica foi realizada com o SPSS (Statistcal Package for Social Sciences), e incluiu media com desvio-padrao. RESULTADOS: Trespacientes (30%) relataram diminuicao no numero e intensidade da encefalopatia. Nao houve casos de peritonite bacteriana espontânea e sangramento gastrointestinal, e nao houve aumento na gravidade da ascite. Dois pacientes relataram melhora no prurido, e quatro melhora no estado geral em poucas semanas apos sessoes de oxigenoterapia hiperbarica. CONCLUSAO: A oxigenoterapia hiperbarica pode melhorar a funcao hepatica na cirrose e ajudar a controlar as complicacoes relacionadas a insuficiencia hepatica na avaliacao pre-operatoria para transplante de figado.

Efeito da oxigenoterapia hiperbárica: relato de caso de paciente com síndrome hepato-pulmonar em lista de espera para transplante hepático

INTRODUCTION: Progressive impairment of liver function in hepatic cirrhosis is a major medical problem with limited therapeutic approaches, and liver transplantation is the only effective therapy. Reports of alternatives for liver function improvement on patients awaiting liver transplantation may include hyperbaric oxygen therapy. CASE REPORT: A 65-year old woman had diagnosis of hepatitis C and liver cirrhosis during treatment for breast cancer. In addition to liver failure and a MELD of 16, the patient presented hypoxemia with a PaO2 of 60 mmHg, and further evaluation with eco-Doppler revealed a hepatopulmonary syndrome. Clinical improvement was attempted with hyperbaric oxygeniotherapy, and substantial clinical and laboratorial improvement was acheived after 10 sessions, with significant improvement on cyanosis and arterial gas values. CONCLUSION: Oxygen therapy was effective in the improvement of dyspnea and hypoxemia secondary to hepatopulmonary syndrome in a patient with liver cirrhosis indicated for liver transplantation. The positive results of this treatment suggest that hyperbaric oxygen therapy may help on improvement of symptoms of hepatopulmonary syndrome.

PROSPECTIVE STUDY OF ASPIRIN FOR THROMBOEMBOLISM PROPHYLAXIS IN TOTAL HIP ARTHROPLASTY

ABSTRACT Objectives: To evaluate the effectiveness of aspirin as prophylaxis for deep venous thrombosis (DVT) in patients undergoing total hip arthroplasty (THA), and to analyze the incidence of bleeding during the post-operative period. Methods: This prospective study carried out in 2017 consisted of 37 patients indicated for THA with high risk for DVT. Immediately after the procedure, aspirin, elastic compression socks and early deambulation were initiated. Doppler ultrasound was performed in the legs 6 days and 6 weeks post-procedure to rule out venous thromboembolism. Hematometric variables and clinical criteria were used to detect bleeding. Results: The incidence of VTE (venous thromboembolism) 6 days post-procedure was 21.6%. By 6 weeks post-procedure, it dropped to 8.1%, (p = 0.102). Only 2.7% were diagnosed with VTE, 6 days and also 6 weeks post-procedure. Within the immediate postoperative period, hemoglobin was lower (p < 0.001), in contrast to 6 weeks after surgery, when it returned to baseline levels. Conclusion: Aspirin was an effective chemical prophylaxis for venous thromboembolism in high-risk patients who underwent THA. There was no clinical record of postoperative bleeding and hematometric levels suggested that there was no chronic bleeding. Level of Evidence II; Prospective study.

PHYSICAL ACTIVITY, QUALITY OF LIFE AND BODY IMAGE OF CANDIDATES TO BARIATRIC SURGERY

ABSTRACT Background: Physical activity enhances quality of life and body image in obese. Behavioural changes are useful tools to increase life conditions of this population. Aim: To evaluate the physical activity level of candidates to bariatric surgery and its relation with quality of life and body image, when patients are encouraged weekly by personal trainers. ) Method: This is a prospective, interventional and longitudinal study with quantitative analysis. Patients were divided into two groups, control (n=28) and interventional (n= 10). Both groups received physical activity and nutritional recommendations and psychological support. Were used the SF36 and Body Shape questionnaires to assess physical activity level and body image and pedometers to count weekly steps. Patients were followed during 12 weeks. ) Results: Were found significant difference in the domains physical activity (p=0.019), pain (p=0.0001) and health general status (p=0.021). No significant difference in body weight (p=0.095) was noted. Conclusion: When assisted by personal trainers, obese patients can change behavior, increase health quality and physical activity levels and experience less pain. Increase in physical activity, when well structured can benefit these patients.

ANALYSIS OF BIOMECHANICAL PARAMETERS IN COLONIC ANASTOMOSIS

ABSTRACT Background: The use of measures in colonic anastomoses to prevent dehiscences is of great medical interest. Sugarcane molasses, which has adequate tolerability and compatibility in vivo, has not yet been tested for this purpose. Aim: To analyze the biomechanical parameters of colonic suture in rats undergoing colectomy, using sugarcane molasses polysaccharide as tape or gel. Methods: 45 Wistar rats (Rattus norvegicus albinus) were randomized into three groups of 15 animals: irrigation of enteric sutures with 0.9% saline solution; application of sugarcane molasses polysaccharide as tape; and sugarcane molasses polysaccharide as gel. The rats underwent colon ressection, with subsequent reanastomosis using polypropylene suture; they were treated according to their respective groups. Five rats from each group were evaluated at different times after the procedure: 30, 90 and 180 days postoperatively. The following variables were evaluated: maximum rupture force, modulus of elasticity and specific deformation of maximum force. Results: The biomechanical variables among the scheduled times and treatment groups were statistically calculated. The characteristics of maximum rupture force and modulus of elasticity of the specimens remained identical, regardless of treatment with saline, polysaccharide gel or tape, and treatment time. However, it was found that the specific deformation of maximum force of the intestinal wall was higher after 180 days in the group treated with sugarcane polysaccharide gel (p=0.09). Conclusion: Compared to control, it was detected greater elasticity of the intestinal wall in mice treated with sugarcane polysaccharide gel, without changing other biomechanical characteristics, regardless of type or time of treatment.

Metabolic and endocrinological factors related to nephrolithiasis pre and post multiple techniques of bariatric surgery: a sistematic review

Introduction Despite of benefits of bariatric surgery for obesity treatment, the procedure may be related to some complications. Aim Analyze studies to address the relation between nephrolithiasis and bariatric surgery. Methods Ten papers about this theme were selected from 2005-2013 in Pubmed, describing the relation of nephrolithiasis or their risk factors with several types of bariatric surgery. Results Retrospective studies with minimal follow-up of three years demonstrated 7,65% in surgery patients and 4,63% non-surgery with nephrolithiasis (p<0,05). Prospective studies (8 of 10) revealed large percentage of calculi appearing and significant increase in oxaluria. Conclusion There is correlation between obesity surgery and nephrolithiasis.

Neoplasia cística mucinosa do pâncreas durante a gestação: Relato de Caso

O objetivo deste estudo e relatar o caso de uma gestante de 20 anos portadora de neoplasia cistica mucinosa do pâncreas. Evidencias sugerem que essa neoplasia e dependente dos hormonios estrogeno-progesterona levando a um importante crescimento durante a gestacao e ainda apresentar, mesmo baixo, um potencial para degeneracao maligna. O motivo deste relato e a raridade da doenca associada a gestacao em uma paciente tao jovem. Foi realizada pancreatectomia corpo-caudal no segundo trimestre da gestacao com boa evolucao materna e fetal.