Simone Corrêa Rosa

Sepsis in burned patients

A prospective study was conducted from June 2001 to May 2002 at the Burns Unit of Hospital Regional da Asa Norte, Brasília, Brazil. During the period of the study, 252 patients were treated at the Burns Unit, 49 (19.4%) developed clinically and microbiologically proven sepsis. Twenty-six (53.1%) were males and 23 (46.9%) females with a mean age of 22 years (range one to 89 years) and mean burned body surface area of 37.7 +/- 18.4% (range 7 to 84%). Forty-three patients had flame burns, five a scald and one an electric burn. These 49 patients had a total of 62 septic episodes. Forty (81.6%) patients had only one and nine (18.4%) had up to three episodes of sepsis. Thirty (61.2%) patients had their first septicemic episode either earlier or by one week postburn. Out of 62 septic episodes, 58 were due to bacteria and four due to Candida sp. The most common bacteria isolated from blood culture were Staphylococccus aureus, coagulase-negative Staphylococcus, Acinetobacter baumannii, Enterobacter cloacae and Klebsiella pneumoniae. Eleven (18.9%) episodes were due to oxacillin resistant Staphylococcus aureus. Acinetobacter baumannii was sensitive to ampicillin/sulbactam in 71.4% and to imipenem in 85.7% of the cases. The primary foci of sepsis were the burn wound in 15 (24.2%) episodes. The most common clinical findings of sepsis in these patients were fever, dyspnea, hypotension and oliguria. The most common laboratory findings of these patients were anemia, leukocytosis, hypoalbuminemia and thrombocytopenia. Twelve (24.5%) patients died. The appropriate knowledge of clinical, epidemiological, laboratorial and microbiological aspects of sepsis in burned patients permits an adequate diagnosis and treatment of this complication.

Perfil epidemiológico do trauma de face dos pacientes atendidos no pronto socorro de um hospital público

RESUMO: Objetivo: Avaliar os dados epidemiologicos e a localizacao dos traumas de face de pacientes atendidos no Hospital Regional da Asa Norte (HRAN), Brasilia, Distrito Federal. Metodo: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRANDF, visando avaliar o perfil epidemiologico dos pacientes atendidos pela equipe da Unidade de Cirur gia Plastica vitimas de trauma de face no periodo de 1 de janeiro a 31 dezembro de 2004. Resultados: O estudo compreendeu 711 pacientes, destacando-se o sexo masculino (72,8%). Quanto a causa, predominou a agressao fisica, seguida por acidente com veiculos/motos. As quedas foram a causa predominante das lesoes em criancas, mas verificou-se a participacao cada vez maior da agressao fisica como mecanismo de trauma facial com o aumento da idade. A relacao de homem:mulher foi de 3:1. A faixa etaria mais atingida foi de 21 a 30 anos, representando 35,3% dos pacientes. As fraturas foram encontradas em 24,9% das lesoes faciais. O nariz foi o local mais acometido nas fraturas de face (76,8%). Conclusao: A violencia interpessoal foi a principal causa de trauma de face. A queda da propria altura mostrou-se como importante mecanismo de trauma nos extremos de idade (Rev. Col. Bras. Cir. 2008; 35(1): 009-013). Descritores: Face; Traumatismos maxilofaciais; Ossos da face; Traumatismos faciais; Ferimentos e lesoes; Violencia; Cirurgia.

Fatores de risco da sepse em pacientes queimados

BACKGROUND: The advances of the treatment of burns have decreased the mortality rate and improved the quality of life of burned patients. Our objective is to analyse, through a case-control study, the risk factors of sepsis in burned patients. METHODS: This case-control study included cases which were treated as in-patients at the Burn Unit of Hospital Regional da Asa Norte, Brasilia, Brazil, during an one year period. RESULTS: Forty-nine (19.4%) patients had sepsis amongst 252 cases admitted to the Burn Unit during the period of study. They had one to three septic episodes amounting to a total of 62. Twenty-six (53.1%) were males and the mean age was 22 years (range one year old to 89 years old). The total body surface area burned from the cases of sepsis varied from seven to 84% with a mean of 37.7 ± 18.4%, was significantly higher than controls. The most common bacteria isolated from the blood culture of the cases of sepsis were Staphylococcus aureus (46.5%), Staphylococcus coagulase negative (20.7%), Acinetobacter baumannii (12.1%) and Enterobacter cloacae (12.1%). Thirty (61.2%) patients had their first septic episode either earlier or by one week postburn. The risk factors for sepsis were the use of three or more catheters, the presence of two or more complications, total body surface area burned > 30%, flame as cause of the burn and female sex. In general, the letality rate of sepsis was 24.5%. CONCLUSION: The appropriate knowledge of risk factors of sepsis in burned patients permit early treatment of this complication, with an adequate systemic antibiotics, thus contributing to decrease the morbidity and letality of these patients.

Self-inflicted burns: attempted suicide

OBJECTIVE To analyze the incidence, characteristics, behavior and mortality rate of patients with self-injury by burns admitted to the Burns Centre of Brasilia, Federal District, Brazil. METHODS The study population consisted of burned patients consecutively admitted to the Burns Unit of Hospital Regional da Asa Norte, Brasília, Federal District, Brazil, during the period from February 2008 to February 2009. Data were obtained on admission and were prospectively recorded during hospitalization. Patients were followed until discharge or death. RESULTS During the study period, 15 cases were admitted due to self-injury burns in the Unit. The mean age was 38.0 ± 20.6 years, 66.7% of cases of self-injury burning were women. In most cases they were married, home providers and poor. The biggest reason was marital conflict. The mortality rate was 40%. The average burned body surface was 38.7 ± 26.1%. Alcohol was used by 66.7% of patients to cause the burns. The average duration of treatment was 20.1 ± 14.8 days. Self-injury burned patients had more extensive lesions, remained in hospital for longer periods and had worse prognosis. CONCLUSION Patients with self-inflicted burns had a mean higher age, higher burned body surface, longer hospitalization, more infectious complications and higher mortality rate than patients with accidental burns. These patients need constant psychiatric support, which can be helpful in preventing future episodes of self-harm.

An experimental study of tissue reaction to polymethyl methacrylate (PMMA) microspheres (Artecoll) and dimethylsiloxane (DMS) in the mouse.

Various methods are available for the treatment of scars, wrinkles, and other cutaneous defects, and the material used must be as biocompatible as possible. This study analyzes the biological behavior of polymethyl methacrylate/bovine collagen (Artecoll) and of polydimethylsiloxane (DMS), using a histopathological study in mice. A prospective study was performed using 40 mice for each substance: polymethyl methacrylate/bovine collagen or polydimethylsiloxane was injected into the right ear, the left ear being used as a control. Histopathological analyses of the right ear, liver, and kidney were performed at intervals during the study and revealed the development of an intense granulomatous reaction of the foreign body type in the right ear, periportal and intralobular infiltrates in the liver, and interstitial nephritis and chronic pyelonephritis in the kidney for polymethyl methacrylate/bovine collagen. A variable reaction with less intense fibrosis and a reduced foreign body reaction were seen in the mice injected with polydimethylsiloxane.

An experimental study of tissue reaction to hyaluronic acid (Restylane) and polymethylmethacrylate (Metacrill) in the mouse.

Abstract:The aging skin is a challenge for medical science. Plastic surgeons and dermatologists are called every day to solve problems like filling wrinkles or folds. The material used must be biocompatible because abnormal reactions may cause catastrophic results. This study analyzes the biological behavior of polymethylmethacrylate (Metacrill) and hyaluronic acid (Restylane), using a histopathologic study in mice. A prospective study was performed using 40 mice for each substance: polymethylmethacrylate or hyaluronic acid was injected into the right ear, the left ear been used as a control. Histopathologic analyses of the right ear, liver, and kidney were performed at intervals during the study and revealed the development of a granulomatous reaction with fibrosis and absorption of spheres and signs of liver and kidney sistematization for polymethylmethacrylate. A discrete cellular reaction, with less formation of fibrosis, and no giant cells were seen in the mice injected with hyaluronic acid.

Reconstruction of face and scalp after dog bites in children

OBJECTIVE to evaluate the immediate reconstruction of face and scalp after canine bites in children. METHODS we conducted a prospective series of cases treated at the Emergency Unit of the Asa Norte Regional Hospital, Brasília - DF, from January 1999 to December 2014. At the time of patient admission to the emergency, the primary wound closure of the face and scalp bite was performed, regardless of the time or day of the event. The primary treatment of the bites was by means of direct suture, flaps rotation or grafting, depending on the type of wound and surgeons decision. RESULTS the study comprised 146 children, with the zygomatic region and scalp being the main sites of head bites. All patients received surgical treatment within the first 24 hours after admission. There were no infectious complications in the cases studied. CONCLUSION the findings suggest that the immediate closure of canine bites on the face and scalp in children is safe, even when carried out several hours after injury.

Reconstrução de couro cabeludo após mordedura canina

BACKGROUND: Evaluation of the management of immediate scalp reconstruction after dog bites. METHODS: There were 55 victims of dog bites on the head seen on the emergency room of the Plastic Surgery Unit, Hospital Regional da Asa Norte (HRAN, Brasilia, DF, Brazil) from January, 1999 through December, 2001. RESULTS: Nine (16.4%) patients had extense injuries on the scalp. From these patients, seven (77.8%) were less than ten years old. The treatment was suture of the lesion of most cases (77,8%). The other cases (22.2%) were treated with graft of the scalp. There was no infection on this series of cases. CONCLUSIONS: The results indicate that immediate closure of dog bite injuries to the scalp is safe, either by direct suturing or scap grafting.

Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery

OBJECTIVE to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. METHODS we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. RESULTS we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. CONCLUSION the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

Acute Intestinal Obstruction Due to Internal Hernia After Abdominal Dermolipectomy

Dear Editor, We know that Roux-en-Y gastric bypass is currently considered the gold standard treatment for morbid obesity [1]. Internal hernias are one of its potential complications, with an incidence ranging from 0.8 to 5% [1–3]. Intestinal obstruction due to internal hernia in patients undergoing gastric bypass is already well documented in the literature, but the occurrence of obstruction after abdominal dermolipectomy in post-bariatric patients is still rarely reported. In such cases, exploratory surgery and proper treatment cannot be delayed due to the high risk of damage to the herniated intestinal loop [4]. In this letter, we aimed to describe a symptomatic case of intestinal obstruction due to internal hernia in a post-bariatric patient who underwent abdominal dermolipectomy. A 46-year-old woman underwent open Roux-en-Y gastric bypass 6 years prior. Her total weight loss was 75 kg (BMI prior to gastric bypass, 53.27 kg/m), and her current BMIwas 29.05 kg/m. The patient had no gastrointestinal symptoms. Following weight loss, the patient underwent anchor-line abdominal dermolipectomy (Fig. 1). On the first and second postoperative days, the patient complained of bilateral back pain and nausea, which worsened on the third postoperative day. On the fourth day after the procedure, she went to the emergency room at the same hospital reporting symptoms of abdominal pain, nausea and vomiting. An abdominal X-ray revealed distension of the small bowel loops and fluid-air levels (Fig. 2). Computed tomography of the abdomen showed significant distension and edema of the small bowel loops, as well as diffuse fluid-air levels, especially in the left hypochondrium. The dilated and abundant intestinal loops were located anterior to the spleen and posterior to the stomach. In addition, the latter test also suggested an abundance of a possible Roux segment within a smaller sac (Fig. 3). Twelve hours after arriving at the hospital, the patient developed persistent pain, abdominal distension in the four abdomen quadrants, and decreased bowel sounds. The diagnosis of acute intestinal obstruction secondary to internal hernia was considered. After antimicrobial prophylaxis, the patient underwent exploratory laparotomy with hernia reduction followed by a hernial orifice repair. Small bowel loop herniation through an opening in the transverse mesocolon was found during exploratory laparotomy. There was no evidence of ischemia or any vascular damage to the loops, which were carefully reduced after cephalic reflection of the colon. The Roux segment was reattached to the transverse mesocolon using a continuous seromuscular suture. Petersen’s space was closed, as was the defect in the mesentery of the entero-entero anastomosis. The patient had a postoperative recovery without complications and was discharged on the third postoperative day. We know that internal hernias are a known cause of intestinal obstruction following Roux-en-Y gastric bypass, with an estimated incidence of 0.8 to 5%, especially when the laparoscopic route is chosen [5–8]. It is believed that the decrease in intra-abdominal fat after weight loss causes an elongation of mesenteric defects. However, there are few reports of the occurrence of internal hernias after abdominal dermolipectomy in post-bariatric patients. The increased risk in these patients is known, but the occurrence of internal hernias after abdominoplasty is rare [4]. * Jefferson Lessa Soares de Macedo scrmacedo@yahoo.com.br