Luiz Carlos Von Bahten

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.

Infection on the meshes implantation area in the abdominal wall of rats with induced bacterial peritonitis

PURPOSE: Evaluate incidence of bacterial growth on implanted meshes in the abdominal wall of rats after to induce bacterial peritonitis. METHODS: 36 rats were used. They were allocated in two groups: group B, experiment group (n =18) and group S, control group (n =18). They were submitted to the implant of polypropylene meshes on the abdominal wall, at the preperitoneal space. Then, in the animals of the experiment group, the induction of peritonitis was made through the inoculation in the peritoneal cavity of standardized solution of Escherichia coli. In the animals of the control group it was made through the inoculation of physiologic solution. The animals of both groups were reallocated in three subgroups of six animals and observed until the reoperations time, for evaluation of the implantation sites, collection of the meshes for cultures, evaluation of the abdominal cavity and peritoneal lavage for cultures. The reoperations occurred in 24, 48 and 72 hours. RESULTS: All the animals of the experiment group presented clinical symptoms of peritonitis. The cultures of the meshes taken off from the implantation sites were positive in 83% of the animals when the moment of the evaluations was of 24 hours, decreasing to 33% in 48 hours and 17% in 72 hours. Globally, it was of 44%. In the animals of the control group there was no case of positive culture neither in the meshes, nor in the peritoneal lavages. CONCLUSIONS: The experimental model used was effective, producing 100% of peritonitis. The incidence of bacterial growth on the implanted polypropylene meshes was 83% in 24 hours, decreasing with the time.

Papel da laparoscopia no trauma abdominal penetrante

BACKGROUND: The role of laparoscopy in reducing the rate of non-therapeutic laparotomies and the morbidity in patients sustaining penetrating abdominal trauma has been widely discussed over the last years. The aim of this article is to report the initial experience from a university hospital in the laparoscopic management of penetrating abdominal traumas. METHODS: In a 3-year period, laparoscopy was performed in 37 patients who were hemodynamically stable and sustained penetrating abdominal trauma. Medical records were reviewed and the evaluation was conducted to determine indications for laparoscopy, associated injuries, the need for exploration, lenght of hospital stay and complications. RESULTS: There were 18 (48.6%) positive and 19 (51.4%) negative diagnostic laparoscopies (DL). In patients with positive DL, 8 (44.4%) underwent exploratory laparotomy. In this group, all of them had either therapeutic laparotomy or laparotomy for better lesion identification. There were 10 (55.6%) positive DLs, in whom laparotomy was not performed. Four of them had their injuries repaired laparocopically, hepatorraphy (n=2) and diaphragmatic repairs (n=2). The other ones had isolated nonbleeding injuries, and nontherapeutic laparotomy was successfully avoided. Patients were allowed a diet in the first postoperative day and the mean postoperative hospital stay was 3.8 days. CONCLUSION: Our initial experience confirms that laparoscopy is a good method of evaluation and treatment for penetrating trauma. The morbidity from an unnecessary laparotomy may be minimized when the procedure is well indicated, and treatment can be performed successfully in selected cases.

O impacto econômico do trauma em um hospital universitário

ABSTRACT Background: The aim of this study is to determine the economic impact of trauma in an university hospitalin Curitiba. Methods: A retrospective study of medical registries was carried out and they were divided inaccordance to trauma mechanism, number of in-hospital days and total medical assistance costs were alsoconsidered for each patient on the In-Hospital Authorization Form. From these data, the average cost,average in-hospital days and average patient/day costs were calculated. Results: The average cost for the349 patients was US

Fatores prognósticos em pacientes submetidos à cirurgia por trauma pancreático

568.22; for fire gun victims, US

Ferimentos cervicais: análise retrospectiva de 191 casos

692.50; for blade victims, US

Epidemiological analysis of polytrauma patients with kidney injuries in a university hospital

676.90; aggressionvictims, US

Manuseio da síndrome compartimental abdominal em unidade de tratamento intensivo

412.30; fall victims and traffic accident victims, US

Successful endovascular management of a traumatic aortic rupture in a pediatric patient: case report and literature review

600.03. The average in-hospital days forthe total sample was 6.2; fire gun victims, 7.7; blade victims, 5.3; aggression victims, 6.7; fall victims, 7 andtraffic accident victims was of 6. The average patient/day cost, for the total sample, was US