Hamilton Petry de Souza

Gastrectomia em pacientes idosos: análise dos fatores relacionados a complicações e mortalidade

OBJETIVO: Verificar as variaveis que influenciam os resultados pos-operatorios no tratamento do adenocarcinoma gastrico em pacientes idosos. METODO: Foi realizada uma coorte historica onde as principais variaveis em estudo foram: idade, localizacao do tumor, estadiamento, doencas associadas, complicacoes do procedimento cirurgico e mortalidade operatoria. Os pacientes foram separados em dois grupos em relacao a idade [Grupo I (< 65 anos) e Grupo II ( 65 anos)], de maneira que os fatores associados com maior mortalidade fossem analisados de forma independente. RESULTADOS: Foram avaliados 160 pacientes submetidos a resseccao gastrica. A media de idade foi 60,7 anos. Presenca de doencas associadas, classificacao ASA III ou IV e mortalidade operatoria foram associados com individuos mais velhos. Nao houve diferenca entre os grupos em relacao a localizacao do tumor no estomago, resseccao empregada, estagio dos tumores e complicacoes pos-operatorias. A mortalidade operatoria foi 6,1% no Grupo I e 12,9% no Grupo II. O principal fator de risco para o obito na analise univariada foi a presenca de doencas associadas (p<0,03). Na analise multivariada, o unico fator de risco significativo para maior mortalidade foi classificacao ASA mais avancada. CONCLUSAO: Os idosos operados por adenocarcinoma gastrico apresentam fator de risco mais acentuado de morte pos-operatoria. Contudo, a idade cronologica nao pode ser definida como um fator determinante, e sim circunstâncias de doencas associadas e condicoes fisiologicas que os acompanham nessa faixa etaria.

Preoperative embolization of the splenic artery in patients that underwent splenectomy for immune thrombocytopenic purpura

UNLABELLED Transfusion of platelets, red blood cells, or both is usually necessary immediately after splenic artery ligature in patients with immune thrombocytopenic purpura who undergo splenectomy. PURPOSE To investigate whether preoperative embolization of the splenic artery reduced the need for transfusion of platelets, red blood cells, or both. METHODS Twenty- seven consecutive patients that underwent splenectomy for purpura between October 1999 and March 2006 performed by the same surgical team were enrolled. The first 17 patients did not undergo embolization and were compared with the next 10 patients, who composed the embolization group. RESULTS The platelet count in the embolization group rose from a mean 7000 u/microl before to 75000 u/microl after the procedure. There was no need for platelet or red blood cell transfusion in the embolization group; in the group without preoperative embolization, 11 patients (p=0.001) required platelet transfusion and 8 (p=0.01), red blood cell transfusion. CONCLUSION Embolization of the splenic artery before splenectomy is a safe method to avoid blood transfusions in patients with ITP.

Pancreatectomia distal no trauma: estudo multicêntrico

No periodo de cinco anos, 87 doentes com trauma pancreatico foram tratados por pancreatectomia corpo-caudal em cinco servicos de emergencia. A idade variou de 7 a 64 anos (media de 28), sendo que 73 (84%) eram do sexo masculino. O principal mecanismo de trauma foi o ferimento penetrante em 72,5%, com ferimentos por projeteis de arma de fogo em 3/4 dos casos. Lesoes associadas ocorreram em 96% dos doentes. A extensao da resseccao pancreatica correspondeu de 30% a 70%, em 62% dos casos. O baco foi preservado em 45,6% dos 57 doentes que se apresentaram sem lesao esplenica. A taxa de complicacoes foi de 40,2%, sendo a fistula pancreatica e a pancreatite pos-operatoria as mais frequentes. A mortalidade total foi de 12 doentes (13,7%). As conclusoes deste estudo foram as seguintes: a) ha relacao nas taxas de morbidade com o mecanismo de lesao; b) a morbidade e mais frequente em doentes com trauma fechado; c) nao ha diferenca na incidencia de complicacoes com o metodo de fechamento do pâncreas remanescente nem com a extensao da resseccao; d) nao ha relacao da mortalidade com o mecanismo de trauma; e) ha uma tendencia no aumento da taxa de mortalidade no trauma fechado com presenca de lesoes associadas.

Auditoria no uso de antimicrobianos em enfermaria cirúrgica

BACKGROUND: To analyze the use of antibiotics in the surgical ward of a tertiary university hospital through one day audit. METHODS: Data were collected from the charts of hospitalized patients (pre- and postoperative) in a single, random visit in the surgical ward. Antibiotic prescription was classified as prophylactic, empirical, therapeutic intent with a known pathogen, therapeutic intent with an unknown pathogen or without rational basis, according to the preset criteria. RESULTS: From 50 hospitalized patients, 46 were surgical (N=46). Antibiotics were prescribed to 13 subjects (28.3%). Drug association was used in seven patients (53.8%), and nineteen antibiotics were prescribed. Eight drugs (42.1%) were used as empirical or without rational basis, four in each group. Six drugs (31.6%) were used to treat infections with an unknown pathogen, three (15.7%) to treat infections with a know pathogen and two drugs (10.5%) for prophylactic use. CONCLUSION: Despite all concerns about the rational use of antimicrobials, in the studied population, almost half of the drugs were used without proper diagnosis or definite criterion. Antibiotic prescription is still a current problem. It must be faced with seriousness by surgeons, who must know when to indicate, how to indicate, and yet, when not to indicate.

Antibioticoprofilaxia na colecistectomia videolaparoscópica eletiva: estudo prospectivo randomizado e duplo cego

BACKGROUND: To identify the need for antibiotic prophylaxis usage in routine laparoscopic cholecystectomy. METHODS: A prospective, randomized double-blind study was done in patients submitted to routine laparoscopic cholecystectomy from June 2003 to July 2007, with 163 patients divided in two groups: Group A (n=82) received antibiotic prophylaxis with Cefoxitin 2g IV at anesthesia induction; Group B (n=81) received 2 mL of isotonic sodium chloride solution at same time. Surgical technique and team were the same. The purpose of this study was to search the outcome for surgical site infections and superficial or deep abscesses. The patients were examined at 7 and 28 days after surgery. Data were analyzed by Fishers exact test. RESULTS: This study showed infection complication rates of 4.76% in group A and 6.17% in group B. There were no statistical significant differences (p = 0.746) for infection complication rates in both groups. The groups were homogeneous and comparable. CONCLUSIONS: Patients submitted to routine laparoscopic cholecystectomy with low surgical risk do not need antibiotic prophylaxis, because it will not result in lower infection rates.

Raising concerns about the Sepsis-3 definitions

The Global Alliance for Infections in Surgery appreciates the great effort of the task force who derived and validated the Sepsis-3 definitions and considers the new definitions an important step forward in the evolution of our understanding of sepsis. Nevertheless, more than a year after their publication, we have a few concerns regarding the use of the Sepsis-3 definitions.

Fístulas digestivas no trauma

Digestive fistulas are associated with significant morbidity and mortality, representing mayor challenges regarding diagnosis and the requiring management according physiopathologic basis, including hydroeletrolytic therapy, antibiotics, nutritional support, selected surgical handling and skin care. Most of these lesions are postoperative complications, especially in urgency and traumatic situations. Our objective is to revise important aspects regarding gastrointestinal tract fistulas secondary to trauma, emphasizing classification, physiopathology, diagnosis, complications and treatment.

Studies in Health Technology and Informatics, Volume 150

The rapid evolution of telecommunication technology has enabled advances to be made in low cost video-conferencing through the improvement of high speed computer communication networks and the enhancement of Internet security protocols. As a result of this progress, eHealth education programs are becoming a reality in universities, providing the opportunity for students to have greater interaction at live surgery classes by means of virtual participation. Undergraduate students can be introduced to new concepts of medical care, remote second opinion and to telecommunication systems, whilst virtually experiencing surgical procedures and lectures. The better access this provides to the operating theater environment, the patient and the surgeon can improve the learning process for students. An analogical system was used for this experimental pilot project due to the benefits of it being low cost with a comparatively easy setup. The tele-surgery lectures were also transmitted to other universities by means of a Pentium 4 computer using open source software and connected to a portable image acquisition device located in the São Lucas University Hospital. Telemedicine technology has proven to be an important instrument for the improvement of medical education and health care. This study allowed health professionals, professors and students to have greater interaction during surgical procedures, thus enabling a greater opportunity for knowledge exchange.

Tumores neuroendócrinos do trato gastrointestinal

Os tumores neuroendocrinos (TNE) ja foram considerados raridades. Atualmente, atraves de novas tecnicas para seu reconhecimento, tem-se identificado um numero crescente destas neoplasias, sendo possivel estratifica-las em subgrupos, expandindo o espectro dos neoplasmas neuroendocrinos e sua importância na pratica cirurgica atual. A imunocitoquimica, a dosagem de peptideos e os modernos metodos de imagem proporcionam informacoes imprescindiveis para um diagnostico acurado e o tratamento adequado. Este artigo tem por objetivo revisar aspectos referentes aos tumores neuroendocrinos do trato gastrointestinal relativos a historia, fisiopatologia, classificacao atualizada, diagnostico e tratamento.