Ronaldo Webster

Profilaxia antimicrobiana em cirurgia vascular periférica: cefalosporina ainda é o padrão-ouro?

In peripheral vascular surgery, cephalosporins are nowadays regarded as the first choice for operative antibiotic prophylaxis. We have recently observed changes in colonizing patterns, pathogen prevalence and antibiotic susceptibility to antimicrobials. Multiresistant pathogens are becoming more frequent in vascular surgical wound infections, showing regional and local variations as to prophylactic antibiotic susceptibility. Data from the available literature so far have shown no strong evidence for a change in routine surgical antibiotic prophylaxis. We must consider regional and institutional prevalence of pathogen resistance and patterns of antibiotic susceptibility to establish specific guidelines for the use of alternative antibiotics.

Treinamento em microcirurgia vascular: é economicamente viável?

The authors describe their experience at the Experimental Microsurgery Lab of the Plastic Surgery Service of Irmandade Santa Casa de Misericordia de Porto Alegre Hospital ¾ Fundacao Faculdade Federal de Ciencias Medicas de Porto Alegre Medical School, highlighting initial low cost microsurgery training alternatives. They present the experimental results obtained.

The role of ischemic preconditioning at the gracilis muscle of rats in the early phase of reperfusion injury

PURPOSEnVerify the role of ischemic preconditioning (IPC) in ischemia and reperfusion injury on gracilis muscle of rats.nnnMETHODSnWistar rats (n=30) were distributed in three groups, I/R and IPC groups were subdivided concerning ischemia time. A near-amputation model of the posterior limb was produced by a hip joint level incision, preserving the vascular bundle and the femur bone and ischemia was induced for 2 h and 4 h, G-I 2 h/R (n=6) and G-I 4 h/R (n=6), followed by 1 h of vascular reperfusion. The preconditioned groups, G-PCI 2 h (n=6) and G-PCI 4 h (n=6), were preceded by 3 cycles of 5 min of ischemia followed by 5 min of vascular reperfusion before sustained ischemia. In the Control Group, C-G (n=6) animals were subjected to regional approach. The analysis was done with Light Microscopy (LM).nnnRESULTSnThe levels of fibril fragmentation were progressive in the G-I 2 h/R (67% of muscle preservation) and in the G-I 4 h/R (0% of muscle preservation). However in the group of the precondition the lesion degree being in level similar to the group controls in the G-I 2 h/R (100% of muscle preservation) while at G-I 4 h/r occur less protection (67% of muscle preservation). The degree of tissue inflammatory reaction was worst at G-I 4 h/R (0% without inflammation signals) than at G-I 2 h/R (50% without inflammation signals); while in the precondition group G-IPC-2 h (83% without inflammation signals) was better than the G-IPC-4 h (67% without inflammation signals). The vascular stasis was absent only in 17% of the G-I 4 h/R and in 33% of the G-I 2 h/R. In precondition group, however, the vascular stasis was absent in 33% at G-IPC 2 h and absent in 50% at G-IPC 4 h.nnnCONCLUSIONnThe IPC showed, in an earlier phase, a beneficial role at I/R derived injury on gracilis muscle of rats, as proven for the largest preservation of the fibers muscular, smaller inflammatory reaction and smaller vascular stasis.

Aperfeiçoando a mensuração do volume mamário na reconstrução imediata com expansores permanentes

BACKGROUND: The accurate determination of breast volume improves the outcome of reconstructive procedures. The aim of the present study is to correlate the preoperative measurement of breast volume using the plastic shells method with the intraoperative application of the Archimedes principle to assess breast volume in immediate breast reconstruction using permanent expanders in patients having breasts with a small volume and mild ptosis grade. METHODS: Ten patients were enrolled in this retrospective nonrandomized study. Breast volume was measured preoperatively using fixed-volume plastic shells and intraoperatively using the Archimedes method. An appropriate permanent expander was selected and inserted in a retromuscular position. The team classified breast symmetry as poor, good, or very good. RESULTS: Differences between pre- and intraoperative measurements were statistically significant (P < 0.01, Students t-test). Preoperative values were lower than intraoperative values by 15% in 70% of the cases. CONCLUSIONS: Breast volume assessment in immediate reconstruction procedures with permanent expanders can be improved and yield more predictable results by the combined use of different pre- and intraoperative measuring techniques. The method that uses fixed-volume plastic shells tends to underestimate the resected breast volume compared to the intraoperative method that uses the Archimedes principle.

Alterações enzimáticas decorrentes de isquemia muscular esquelética em ratos

The authors studied the enzymatic alterations (CPK, TGO, e LDH) due to skeletal muscle damage in rats submitted to inferior limb ischemia for 0, 2, 4 and 6 hours. Twenty eight rats were divided into four groups: Group I (control), and Groups II, III and IV (ischemia for 2, 4 and 6 hours, respectively). A blood sample was drawn of the retrocular venous plexus after the ischemia period in all animals. The values obtained (mean±standard deviation) for TGO in Groups I, II, III and IV were, respectively: 20,14±6,76; 59,71±28,91; 88,28±11,17 e 123±52,65 U/l. The values for CPK were: 67,85±62,76; 203±108,71; 237,71±95,06 e 291,71±173,19 U/l. For LDH, we obtained: 414,42±222,47; 526±234,75 e 427,57±273,58 U/l. For the statistical analysis, we used the ANOVA method followed by the Bonferronix92s t test (p<0,05). TGO levels obtained were statistically elevated in the Groups III and IV when compared to the control group. For CPK, there were significant difference between the groups IV and I. LDH levels there were not statisticantly different between the groups. The authors conclude which, after 2, 4 and 6 hours of ischemia, the LDH dosage was not an useful parameter in the prediction of muscle damage. TGO and CPK measures were altered significantly after 4 and 6 hours, respectively being useful in the evaluation of muscle ischemia in rats.