Blunt hepatic trauma: comparison between surgical and nonoperative treatment

OBJECTIVE: To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. METHODS: This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. RESULTS: In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. CONCLUSION: A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.OBJETIVO: Analisar a evolução do trauma hepático fechado e comparar o tratamento operatório e não operatório em pacientes admitidos com estabilidade hemodinâmica e nenhuma indicação óbvia de laparotomia. MÉTODOS: Estudo retrospectivo de casos admitidos em um hospital universitário entre 2000 e 2010. Os pacientes submetidos ao tratamento operatório foram distribuídos em dois grupos: a) todos os pacientes submetidos ao tratamento cirúrgico e b) pacientes sem indicações óbvias de laparotomia. RESULTADOS: Neste período, 120 pacientes foram admitidos com trauma hepático fechado. Sessenta e cinco pacientes (54,1%) foram submetidos ao tratamento não operatório e 55 pacientes foram operados. Pacientes submetidos ao tratamento não operatório tiveram melhores parâmetros fisiológicos na admissão, menor gravidade de lesões (exceto pelo grau de lesão hepática), menor necessidade de transfusão sanguínea e menor morbidade e mortalidade quando comparados aos pacientes operados. Os pacientes operados sem indicação óbvia de cirurgia tiveram maiores taxas de complicações e mortalidade do que os pacientes submetidos ao tratamento não operatório. CONCLUSÃO: O tratamento não operatório resultou em menor taxa de complicações, menor necessidade de transfusão sanguínea e menor mortalidade.30731

Blunt Hepatic Trauma: Comparison Between Surgical And Nonoperative Treatment.

To examine the outcomes of blunt hepatic trauma, and compare surgical and non-surgical treatment in patients admitted with hemodynamic stability and with no obvious indications of laparotomy. This is a retrospective study of cases admitted to a university teaching hospital between the years 2000 and 2010. Patients undergoing surgical treatment were divided into two groups: (a) all patients undergoing surgical treatment, and (b) patients with obvious need for surgery. In this period, 120 patients were admitted with blunt hepatic trauma. Sixty five patients (54.1%) were treated non-operatively and fifty five patients were operated upon. Patients treated non-operatively had better physiologic conditions on admission, demonstrated less severe injuries (except the grade of hepatic injury), received less blood components and had lower morbidity and mortality than the patients operated upon. Patients who underwent non-operative treatment had a lower need for blood transfusion but higher rates of complications and mortality than the patients operated upon. Patients who were operated upon, with no obvious indications for surgery, had higher rates of complication and mortality than patients not operated upon. A non-operative approach resulted in lower complications, a lower need for blood transfusions and lower mortality.39307-1

Experiência inicial de um hospital universitário utilizando a telemedicina na promoção de educação através de vídeo-conferências

Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. Retrospective study at Universidade Estadual de Campinas. Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3) teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7), or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution13013236Serviços de telessaúde e telemedicina estão avançando rapidamente, com um espectro cada vez maior de tecnologias da informação e comunicação que podem ser aplicadas de forma ampla para a saúde da população, bem como para a educação médica. O objetivo deste artigo é relatar a experiência da nossa instituição com 100 reuniões por videoconferência entre cinco diferentes países das Américas no período de um ano. Estudo retrospectivo na Universidade Estadual de Campinas. Através de um banco de dados do Microsoft Excel, foram analisadas retrospectivamente todas as conferências realizadas em nossa instituição, de setembro de 2009 a agosto de 2010, em todas as especialidades. Um total de 647 alunos, médicos e professores participaram das reuniões de telemedicina. Em média, 8,3 (± 4,3) teleconferências foram realizadas mensalmente durante o período analisado. Excluindo os feriados e o mês de inauguração do anfiteatro de telemedicina, as nossas taxas de teleconferência atingiram a média de 10,3 (± 2,7), ou duas teleconferências sobre uma média semanal. Cirurgia do Trauma e reuniões sobre segurança dos pacientes foram, de longe, os temas mais comuns discutidos em nossas reuniões de teleconferência, correspondendo por 22% e 21% do total de chamadas. Nossa experiência com as reuniões de telemedicina aumentou o interesse dos alunos, ajudou a nossa instituição a acompanhar e discutir protocolos que já são aceitos em todo o mundo e estimulou nossos professores a promover pesquisas relacionadas à telemedicina em suas próprias especialidades, mantendo-os atualizados. Essas reuniões com envolvimento de alta tecnologia encurtaram as distâncias dentro de nosso país vasto e com outros centros de referência no exterior. Esta proximidade virtual permitiu discussões com alunos e residentes sobre estágios internacionais a fim de aumentar seu conhecimento global e melhorar a sua educação dentro da própria instituiçã

Prognostic factors in penetrating colon inuries

Orientadores: Gustavo Pereira Fraga, Elcio Shiyoiti HiranoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: A lesão de cólon, que ocorre em 25% a 41% dos ferimentos por projétil de arma de fogo (FPAF) e em 5% a 20% dos ferimentos por arma branca (FAB) que acometem o abdome, apesar de possuir baixa mortalidade, apresenta uma alta morbidade. O presente estudo teve como objetivo analisar quais os fatores prognósticos envolvidos no aumento da morbidade e da mortalidade no trauma penetrante do cólon. Foi realizado um estudo retrospectivo de 21 anos, em que 462 pacientes foram admitidos com trauma de cólon, excluindo os traumas contusos e lesões grau I, sendo incluídos neste estudo 324 pacientes. Destes, 90,7% eram do sexo masculino, com média de idade de 28,9 anos, sendo que 59,6% encontravam entre 14 e 29 anos. Os FPAF foram responsáveis em 82,4% dos casos. As médias dos escores de trauma foram: RTS de 7,3 (± 1,31), ISS de 16,9 (± 9) e ATI de 25,1 (± 12). Reparo primário foi realizado em 72,2% dos casos. A morbidade global foi de 39,8%, com infecção abdominal em 8% dos pacientes. A mortalidade foi de 13,6%. Fístula ou deiscência de anastomose aconteceu em 14 pacientes (4,3%), sem fator de risco específico para sua ocorrência. Lesões destrutivas do cólon e pacientes com RTS alterado na admissão apresentaram maior taxa de morbidade e mortalidade. Pacientes com hemoperitônio estimado em mais de 1000 mL, múltiplas lesões abdominais associadas e lesões torácicas associadas com o cólon também apresentaram aumento da morbidade. Aqueles pacientes com ISS maior ou igual a 25, que necessitaram de transfusão sanguínea ou apresentaram coagulopatia e com lesões de estômago associada ao cólon apresentaram maior taxa de mortalidade. Conclui-se que é possível predizer o risco de complicações em grupo selecionados de pacientes com trauma penetrante de cólonAbstract: Colon injuries have a low morbidity, but a high mortality. They occur in 25 to 41% of gunshot and 5 to 20% of stab wound injuries in the abdomen. The present study aims to determine the prognostic factors involved in increased morbidity and mortality rates for penetrating colon trauma. The present study is a retrospective analysis over the last 21 years, were 462 patients were admitted with colon trauma. Patients with blunt trauma and with grade I injuries were excluded. A total of 324 patients were included in the study. Of these patients, 90.7% were male, with a mean age of 28.9 years, with 59,6% of patients between 14 and 29 years old. The gunshot injuries were observed in 82.4% of cases. The trauma scores means were: RTS of 7.3 (± 1.31), ISS of 16.9 (± 9) and ATI of 25.1 (± 12). Primary repair was performed in 72.2% of cases. The overall morbidity rate was 39.8 %, abdominal infections were observed in 8% of the. The mortality rate was 13.6%. Fistula or anastomotic leak was present in 14 patients (4.3%), but not associated with specific risk factors. Destructive lesions of the colon and patient presented with an altered RTS score have a higher morbidity and mortality rates. The presence of hemoperitoneum greater than 1000ml, multiple abdominal injuries or thoracic injuries associates with the colon also had a higher morbidity rate. Those patients with ISS greater than or equal to 25, that required blood transfusions or presented coagulopathy, as well as those sustaining gastric lesions in association with the colon also had a higher mortality rate. In conclusion, it is possible to predict complications in selected group of patients with penetrating colon injuryMestradoFisiopatologia CirúrgicaMestre em Ciência

Use of Sengstaken-Blakemore Intrahepatic Balloon: An Alternative for Liver-Penetrating Injuries

Severe lesions in the liver are associated with a high mortality rate. Alternative surgical techniques such as the use of an intrahepatic balloon may be effective and reduce mortality in severe hepatic lesions. This study aimed to demonstrate the experience of a university hospital in the use of the Sengstaken-Blakemore balloon in patients with transfixing penetrating hepatic injury as an alternative way to treat these challenging injuries. A retrospective study based on the trauma registry of a university hospital was performed. All patients admitted with hepatic penetrating injuries and treated with the Sengstaken-Blakemore balloon within the period 1990-2010 were reviewed. Forty-six patients with transfixing hepatic injuries were treated with the Sengstaken-Blakemore balloon in the study period. The most frequent cause of injury was gunshot wound (87 % of the patients). The mean trauma scores on admission were Revised Trauma Score (RTS) = 7.12 +/- A 1.46, Injury Severity Score (ISS) = 22.4 +/- A 9.7, and Abdominal Trauma Index (ATI) = 19.5 +/- A 11. According to the severity of the hepatic trauma, 71.8 % of patients had grade III, 23.9 % grade IV, and 4.3 % grade V injuries. Associated abdominal injuries were found in 89.1 % of the patients. The most frequent liver-related complications were hepatic abscess postoperative bleeding (8.6 %), biliary fistula (8.6 %), (4.3 %), and biliary peritonitis (2.1 %). Surgical reintervention was necessary in 14 patients (31.1 %). From those 14, only 3 had the balloon removed. The overall morbidity and mortality rates were 56.5 % and 23.9 % (11 patients), respectively. The knowledge of alternative surgical techniques is essential in improving survival in patients with severe penetrating hepatic injuries. The use of intrahepatic balloon is a viable surgical strategy.3692119212

Use of sengstaken-blakemore intrahepatic balloon : an alternative for liver-penetrating injuries

Severe lesions in the liver are associated with a high mortality rate. Alternative surgical techniques such as the use of an intrahepatic balloon may be effective and reduce mortality in severe hepatic lesions. This study aimed to demonstrate the experience of a university hospital in the use of the Sengstaken-Blakemore balloon in patients with transfixing penetrating hepatic injury as an alternative way to treat these challenging injuries. A retrospective study based on the trauma registry of a university hospital was performed. All patients admitted with hepatic penetrating injuries and treated with the Sengstaken-Blakemore balloon within the period 1990–2010 were reviewed. Forty-six patients with transfixing hepatic injuries were treated with the Sengstaken-Blakemore balloon in the study period. The most frequent cause of injury was gunshot wound (87 % of the patients). The mean trauma scores on admission were Revised Trauma Score (RTS) = 7.12 ± 1.46, Injury Severity Score (ISS) = 22.4 ± 9.7, and Abdominal Trauma Index (ATI) = 19.5 ± 11. According to the severity of the hepatic trauma, 71.8 % of patients had grade III, 23.9 % grade IV, and 4.3 % grade V injuries. Associated abdominal injuries were found in 89.1 % of the patients. The most frequent liver-related complications were hepatic abscess postoperative bleeding (8.6 %), biliary fistula (8.6 %), (4.3 %), and biliary peritonitis (2.1 %). Surgical reintervention was necessary in 14 patients (31.1 %). From those 14, only 3 had the balloon removed. The overall morbidity and mortality rates were 56.5 % and 23.9 % (11 patients), respectively. The knowledge of alternative surgical techniques is essential in improving survival in patients with severe penetrating hepatic injuries. The use of intrahepatic balloon is a viable surgical strategy3692119212