Gutemberg Fernandes de Araújo

Ventilação não invasiva no pós-operatório imediato de derivação gastrojejunal com bypass em Y de Roux

BACKGROUND: Morbidly obese patients develop more atelectasis during general anesthesia than non-obese ones, and these atelectasis persist for 24 hours after the end of the surgical procedure. OBJECTIVES: This study evaluated the effect of noninvasive ventilation with two pressure levels (BiPAP) in the pulmonary function, incidence of immediate postoperative pulmonary complications and the development of anastomotic dehiscence in morbid obese patients submitted to gastrojejunal derivation in Roux-en-Y (RYGB). METHODS: It was an analytical and clinical study involving patients who were submitted to RYGB, had a body mass index (BMI) of at least 35 kg/cm2, and were randomly chosen to receive BiPAP (experimental group) or standard oxygen therapy (control group), in the first four hours of the post-operation period. Patients with chronic or acute pulmonary disease were not included, and neither were the ones who needed invasive mechanical ventilation by the end of the surgery. Vital capacity, maximal inspiratory and expiratory pressure, and arterial blood gases were measured in the preoperative and in the first postoperative. Chest X-ray was performed in the third postoperative. RESULTS: Eighteen patients were chosen for the study: ten received BiPAP and eight received standard oxygen therapy. The study group had better partial oxygen pressure and lower maximal expiratory pressure levels in the postoperative state than the control group. Anastomotic dehiscence was not observed in any group. There was no significant difference between the control group and the study group relating to the loss of vital capacity, maximal inspiratory pressure in the postoperative period or the incidence of atelectasis. CONCLUSION: The BiPAP in the postoperative period of gastroplasty was useful to improve oxygenation and did not increase the incidence of anastomotic dehiscence.

Parenteral nutrition versus enteral nutrition in severe acute pancreatitis

PURPOSE To compare the effect of parenteral versus enteral nutritional support in severe acute pancreatitis, with respect to efficacy, safety, morbidity, mortality and length of hospitalization. METHODS The study was comprised of 31 patients, divided into a parenteral group (n=16) and an enteral group (n=15), who met severity criteria for abdominal tomography (Balthazar classes C, D, and E). The patients were compared by demographics, disease etiology, antibiotic prophylaxis, use or not of somatostatin, nutritional support, complications and disease progression. RESULTS There was no statistical difference in the average duration of nutritional support, somatostatin, or antibiotics in the two groups. Imipenem was the drug of choice for prophylaxis of pancreatic infections in both groups. More complications occurred in the parenteral group, although the difference was not statistically significant (p=0.10). Infectious complications, such as catheter sepsis and infections of the pancreatic tissue, were significantly more frequent in the parenteral group (p=0.006). There was no difference in average length of hospitalization in the two groups. There were three deaths in the parenteral group and none in the enteral group. CONCLUSION Enteral nutritional support is associated with fewer septic complications compared to parenteral nutritional support.

Hepatectomias: análise crítica retrospectiva de 21 casos

OBJETIVO: Analisar os principais aspectos tecnicos e clinicos referentes as resseccoes hepaticas realizadas em um periodo de cinco anos (1994 a 1998). METODO: Estudo retrospectivo de 21 resseccoes hepaticas, com enfase no tipo de resseccao utilizado, o preparo pre-operatorio e as complicacoes do periodo pos-operatorio. Ademais, estabelecer correlacoes com os dados clinicos e epidemiologicos, bem como os exames complementares mais solicitados, em especial, o exame histopatologico. RESULTADOS: Foram realizadas oito resseccoes locais atipicas, quatro segmentectomias, quatro hepatectomias esquerdas, duas hepatectomias direitas, uma lobectomia esquerda, uma trissegmentectomia esquerda e uma trissegmentectomia direita. As resseccoes foram indicadas para tratamento de tumores malignos primarios do figado em nove pacientes; tumores benignos em seis pacientes; miscelânea em tres pacientes; metastases hepaticas em dois e tumor de via biliar em um paciente. As complicacoes pos-operatorias ocorreram em sete pacientes (33%), sendo as mais frequentes o abscesso subfrenico e peritonite e a mortalidade operatoria foi de 9,5%. CONCLUSOES: A cirurgia hepatica tem se tornado cada vez mais factivel e as complicacoes pos-operatorias, sob maior controle clinico, tem diminuido bastante a mortalidade.

Estudo do efeito de dreno de penrose na cavidade peritoneal de ratos

BACKGROUND: To study the effect of a Penroses drain in the peritoneal cavity of 30 Wistar rats divided in three groups, each of them with 10 rats. METHODS: Thirty Wistar rats of the same sex were selected. They were submitted to the placement and fixation of the Penrose drain in the peritoneal cavity. The groups diferred among themselves only in terms of the euthanasia time considered: group I - euthanasia after 24 hours; group II - euthanasia after seven days; group III - euthanasia after 14 days. RESULTS: The formation of adherences were observed in all three groups of animals. In group I weak adherences were observed in six animals, moderate ones in two rats and strong adherences were observed in two rats. In group II weak adherences were observed in one animal, moderate ones in five rats and strong adherences in three animals. In group III, moderate adherences were present in six animals and strong ones were observed in four rats. CONCLUSION: The presence of the Penroses drain in the peritoneal cavity of rats leads to the formation of adherences.