João Eduardo Nicoluzzi

Trauma abdominal fechado: análise dos pacientes vítimas de trauma esplênico em um Hospital Universitário de Curitiba

ABSTRACT Background : determining the common characteristics referring to the trauma mechanism and to the anatomic and physiologicallesion of patients victim of splenic trauma. Method: The records of December/1999 to January/2003 were revised, beingselected 524 of those by the Software TNVT Plus (version 2.0.0.213 – year 1996), admitted in the Emergency Service victims ofthoracic-abdominal disease and subsequently interned. Of these records, were excluded those which did not present mechanismof contused trauma, the ones that deceased in the emergency room and the minors of 16 years of age. A sample with N=200patients were studied. The variables of interest in the study were: etiology of the trauma, organ with the lesion, degree andsegment of the lesion, systolic arterial pressure, cardiac frequency in the hospital admission and rib fracture. Results: thesplenic injury isolated had the greater incidence 39%, the hepatic-splenic associated lesion represented 14%. Of the 116patients with diagnosis of splenic lesion, the classified anatomically in Degree IV was the most common (44 patients). Themajority of the lesions had an auto-engine vehicle as the trauma mechanism – 56 patients, among which the lesion Degree IIIhad greater prevalence 33,93%, standard comparable with the lesion Degree IV 32,14%. It was observed that 20% of thepatients with lesion Degree III, IV or V had not described abdominal pain in their records, and in the lesions Degree I or II30,13% did not describe pain. Medium Cardiac Frequency and Systolic Arterial Pressure were shown equivalent amongdifferent lesions. The greater incidence of splenic lesion was related to the absence of rib fracture. When diagnosed fracture,there was predominance of the group with isolated left ribs fractured, in which lesions Degree III, IV or V predominate with62,50%.

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.

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.

Blunt abdominal trauma: analysis of victims of hepatic trauma in na University Hospital of Curitiba

BACKGROUND: To determine during hospital admissions, the trauma mechanism, anatomical and physiological injuries, abdominal pain and rib fractures of hepatic trauma victims. METHODS: Records from December/1999 to January/2003 were reviewed and 524 were selected by the Software TNVT Plus (version 2.0.0.213 - year 1996), from patients admitted to the Emergency Service, victims of blunt thoracic-abdominal trauma and submitted partial hepatectomy, hepatorrhaphy, laparotomy, reduction or conservative treatment of rib fractures. Those records which didnt present blunt trauma, were excluded, as well as the ones who deceased in the emergency room and those under 16 years old. Therefore, 200 records were analysed. RESULTS: Regarding all liver traumas, 37.63% were caused by motor vehicle accidents,responsible for 54.29% of the most serious injuries (degrees III, IV and V). These injuries caused abdominal pain in 75.86% of the cases, and minor injuries (degrees I and II) caused abdominal pain, in 69.70%. The heart rate and the mean systolic arterial pressure with degree I or II injuries were, respectively, 100.37 beats per minute and 114.45 mmHg; and in those with degree III, IV, or V injuries were 105.69 beats per minute and 107.88 mmHg, respectively. Right rib fracture was associated to degrees I or II injuries in 29.41% of the cases. CONCLUSION: Motor vehicle accidents are the most common cause of hepatic trauma and is the main causes of the most serious injuries. These injuries caused abdominal pain with the same frequency that minor injuries. The heart rate and mean systolic arterial pressure showed no relation to degree of hepatic injury.

Derivação bíleo-digestiva com o ducto do segmento III do fígado em obstrução hilar maligna

Cholangiocarcinoma of the hepatic hilum is a seldom curable lesion. Those patients are often managed with prostheses. Cholangiojejunostomy on the third segment of the liver seems to offer effective biliary drainage with better quality of life compared to other forms of palliation. The aim of this paper is to report a successful case of a patient with irressectable biliary tumor submitted to a surgical biliary drainage.

Ressecção isolada do segmento I sob exclusão vascular hepática total

An isolated hepatic caudate lobectomy was performed in a fifty-seven-year-old white woman presenting a colo-rectal metastasis to hepatic segment I. The resection was performed under total liver vascular exclusion due to the proximity to hepatic veins. The patient presented an uneventful hospitalization being discharged on day seven.